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PCMH: Shouldn't Patients Have Their Say?

Philip Betbeze, for HealthLeaders Media, April 25, 2014

Recent research that casts a pall on the cost and quality effectiveness of the patient-centered medical home is far from the final word on what patients—especially older, expensive ones—say they want from their physicians.

A few weeks ago I wrote about the compelling research published in the Journal of the American Medical Association that showed no effect on healthcare costs from the patient-centered medical home designation and little improvement in quality of care.

The results reported by JAMA are more than a little concerning for people who theorize that team-based, well-coordinated care is more efficient and less costly, and ultimately benefits patients' health.

They're especially concerning for physician practices that feel they need to make the substantial investment required to achieve PCMH designation. Increasingly, that designation—particularly the top achievement, Level III—is being required of primary care practices in order to attain incentives from payers and other healthcare partners.

Though the research reaches troubling conclusions in both ROI and improvement in quality, it certainly does not end the debate or the push for PCMH designation from payers and others.

In an attempt to find as neutral a source as I could regarding this research and the uncertain future of the PCMH, I spoke recently with Christopher Langston, PhD, program director for the John A. Hartford Foundation, a nonprofit based in New York that attempts to improve the health of older adults.

The foundation provides grants for research and education in geriatric medicine, nursing, and social work. It conducted a recent poll of older Americans who overwhelmingly supported the ideas embodied in the PCMH construct, and he also found the results from the JAMA article "troubling."

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1 comments on "PCMH: Shouldn't Patients Have Their Say?"


Randy Wexler MD MPH FAAFP (4/26/2014 at 11:47 AM)
It is unfortunate that a single study (likely because it was in JAMA)has been received as if it is the quintessential study on what a PCMH can do. That is troubling. In this study physicians were paid to achieve NCQA recognition. Not provide PCMH care. This is a very important distinction. In addition they were tasked with recognition under the 2008 requirements, and it was 2011 when quality improvement was added. The Patient Centered Primary Care Collaborative at http://www.pcpcc.org/resource/medical-homes-impact-cost-quality provides overwhelming evidence as to the benefits of PCMH care. Cost is reduced and outcomes improved in those places providing PCMH care, whether NCQA recognized or not. As such, it is what you deliver, not what you call the delivery of care that is important, and the delivery of PCMH care is the key.