Reviewing Patient Centered Medical Home Demonstration Projects

Researchers at Harvard Medical School recently published a review of Patient Medical Home Demonstration projects (PCMH) that have been occurring throughout the country. The goal of a PCMH is to improve primary care quality and limit growth in the cost of health care. The researchers sought to provide an update on the successes and failures of these projects.

The article reports on interviews with staff from 26 different projects in 18 states, which include over 14,000 physicians caring for roughly 5 million patients. Their findings show that PCMHs have not settled in on a single model and that it is unclear whether best-practices have fully been identified. However, they discovered two models that showed promise. A chronic care model that implements quality improvement coaching and a model featuring transformation consultants both demonstrated successes in enhancing care and controlling costs.

Finally, their respondents report that payment reform will be a key determinate of the success of the Medical Home model.  Most PCMHs had adopted a three-pronged payment model, including fee-for-service payments, fixed case management fees, and bonuses paid based on clinical performance. The authors identified that fixed case management feeds represented an underutilized revenue stream by many of the medical homes.

The findings of this review suggest that Medical Home advocates need to identify best-practices in terms clinic operations and treatment deliver and measure quality of care based on patient experience and treatment outcomes. Currently there are so many PCMH models that it is hard to evaluate the effectiveness of each and quality measurement is lacking.

Source: Bitton, A., Martin, C., Landon, B. 2010. A nationwide survey of patient centered medical home demonstration projects. Journal of General Internal Medicine  25(6): 584-92.

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