If they don't get that help, and get bogged down in investments, disagreements about division of labor, and other organizational struggles, the investment in the patient centered medical home is not money well spent. The recent JAMA study, he says, has no real way of knowing the fidelity with which the practices are implementing the model.
"What they knew is what the practice said about whether they've gotten better about referring to other sources, such as for diabetes," he says. "There's no measurement of whether that really happened."
Also, such a study would be more valuable with a segmented population, he adds.
"They tried, but they only had commercial patients, they didn't have the full range," he says. "For example, they don't have people in the last years of life. It's harder to show benefit unless they had the full range and complexity of patients."
He adds that in the case of the PCMH, misimplementation can be worse than nonimplementation.
'Worst of Both Worlds'
"This is a case where half a loaf is not better than no loaf," Langston says. "If you hire someone but they don't know how to use the rules right, you have that added expense, but you don't get the return on investment. It's the worst of both worlds because you have the added expense but you don't achieve outcomes. What really matters is measuring outcomes, tracking them, and rules about what you do when someone doesn't get better," he says.