Patient-Centered Medical Home and Quality Measurement in Small Practices

The patient-centered medical home (PCMH) concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the shortcomings of the current healthcare system.

Components of the PCMH model include practice-based policies and processes intended to improve healthcare quality, patient experience, clinician satisfaction, and costs of care. Pilots and demonstration projects have yielded mixed results, but positive reports associate PCMHs in large practices and institutions with decreases in costs for patients enrolled in Medicaid; increased care of Medicaid patients; and positive patient and clinician experiences. Recently published studies have also shown that components of the medical home (eg, care coordination, pre-visit planning) are associated with positive effects on clinical outcomes for patients and quality of life for clinicians.

The process of transforming and achieving recognition as a medical home can be difficult, especially for small practices with few resources. Additionally, small practices located in low income neighborhoods face challenges unique to their settings (eg, smaller panel size for quality measurement, lack of information systems, and lack of support staff) which can further exacerbate their ability to generate the documentation needed to demonstrate transformation and meet the standards for recognition. Promoting the adoption of PCMH standards in small primary care practices in lower income neighborhoods with a large proportion of chronically ill patients can be advantageous for reducing healthcare inequalities.

As part of a larger public health initiative, the Primary Care Information Project (PCIP), a bureau within the New York City Department of Health and Mental Hygiene, has offered assistance to small, independent practices in New York City to complete the application for the National Committee for Quality Assurance’s (NCQA’s) Physician Practice Connections–Patient Centered Medical Home (PPC-PCMH) recognition program.This study assesses the clinical quality outcomes of PCIP-participating practices that have achieved PPC-PCMH recognition from NCQA, and compares performance on quality measures from 2009 through 2011 in practices that have been PCMH-recognized with those that have not.