JAMA Article on PCMH Pilot Study Underscores the Current Evolution of Medical Home Model

Thursday, Feb. 27, 2014

Statement attributable to:
Reid Blackwelder, MD  
American Academy of Family Physicians

“The American Academy of Family Physicians concurs with the recent assessment by the Patient-Centered Primary Care Collaborative(www.pcpcc.org) in response to this week's JAMA article, ‘Association Between Participation in a Multipayer Medical Home Intervention and Changes in Quality, Utilization, and Costs of Care’, and strongly cautions against reading too much into this one study because of its limitations.

“This research represents another piece of the health care transformation puzzle. To improve an evolving model such as the patient-centered medical home, we must first identify weaknesses and the underlying factors contributing to those limitations. We also must measure progress in implementing the infrastructure necessary to complete medical practice transformation to PCMH. This study is a step in that direction as the PCMH evolves and improves. However, this study is from 2008-2011, and reflects what was true then. We are at a greatly different time now in terms of the maturity and function of PCMH practices. We have more recent data from several other studies that show significant improvement in patient outcomes and access, at lower cost, which are not referenced in the article or commentary.

“We also must keep in mind that designation as a PCMH does not mean a practice will immediately reduce costs. We have always said transforming to an effective PCMH is not easy, nor is it always successful for every practice. Interestingly, the PCMH models that were the focus of this article did not make some of the changes we recommend such as adding extended hours, and still rely on the pay-for-volume/fee-for-service model, rather than on newer blended approaches that shift the focus to paying for value. Moreover, as practices transform to a PCMH, many patients that were once lost to care are found. Diabetics who had not been seen for some time are called back, tested and counseled, and placed on a treatment plan that may initially raise costs and usage, but reduce those costs and usage over time. This process takes time as not every patient who needs to be seen is identified on day one.

“We agree with Thomas Schwenk’s comment, ‘These findings suggest that medical home interventions may need further refinement.’ Transforming to effective PCMH models is a work in progress, and one size does not fit all. We strongly caution against assuming the results of this single study of a single PMCH pilot is the final word on the efficacy of the all-payer PCMH. The study must be viewed within the context of ongoing current research, including that by the Patient-Centered Primary Care Collaborative,(www.pcpcc.org) which has published multiple results from across the nation and has found significant reductions in medical interventions and costs.”

Editor's Note: To arrange an interview with Dr. Blackwelder, contact Leslie Champlin, (800) 274-2237, Ext. 5224, or lchampli@aafp.org.

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