The Patient-Centered Medical Home: A Path Toward Health Equity?

Abstract

Equity was identified as one of the six core dimensions of a high-performing, high-quality health care system in the landmark Institute of Medicine (IOM) report Crossing the Quality Chasm (2001). The report concluded that health care should be “equitable, (that is) providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status” (p. 6). A second IOM report, Unequal Treatment (2002), noted that there were pervasive examples of “differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention” and that “many sources—including health systems, healthcare providers, patients, and utilization managers—may contribute to racial and ethnic disparities in healthcare” (p. 4).

Since the publication of these two reports, an unprecedented number of initiatives to re-design the nature and objectives of the nation’s health care system have been launched. While the passage of the Patient Protection and Affordable Care Act in 2010 formalized federal support for some of these initiatives, there were already a number of significant activities throughout the past decade designed to create a more effective, efficient, equitable, and patient-centered delivery model.

Notably, the concept of the patient-centered medical home (PCMH) was resurrected and revitalized. Originally promulgated by the American Academy of Pediatrics in the 1960s as an idealized set of practices to improve care for children with special needs, the PCMH was redefined and recalibrated to capitalize on the advances ushered in by, among other developments, the electronic health record and other technologically-driven advances in data management. The creation of the Patient-Centered Outcomes Research Institute (PCORI) is also emphasizing a patient-centered orientation and the need for stakeholder engagement in research.

Additionally, the consolidation of major segments of the health care system, including hospitals, multispecialty practices, and primary care also contributed to the reinvigoration of interest in the PCMH. The PCMH promises to ease fragmentation by leveraging underlying capabilities in infrastructure and data to achieve improved health outcomes and better patient experiences. Widespread adoption of the PCMH can overcome the fragmentation that has gradually eroded the relationship between physicians and their patients. Patients who are assigned to a PCMH will receive higher-quality and more effective care; this, in turn, will lead to higher patient satisfaction. In addition, the PCMH offers the tantalizing promise of reduced waste and redundancy, ultimately resulting in lower costs to the health care system.