What we now know about the patient-centered medical home

Three years and some $8 million ago, the AAFP boldly launched TransforMed, whose primary mission was to carry out a national demonstration project (NDP) to test a model of the patient-centered medical home (PCMH) in 36 practices throughout the United States.

Yesterday, the first researchers' report, based primarily on the project's qualitative data, was published in the Annals of Family Medicine. According to the researchers, "Even though analysis of the NDP is not yet complete, we feel compelled to share early lessons ...  We have already learned enough from the NDP to identify some potentially dangerous red flags fluttering over the [PCMH] demonstrations just getting underway."

Here's what the researchers found:

1. Becoming a PCMH (as defined by the TransforMed model, now on version 2.3) requires "epic," "relentless," "practice-wide" change that will likely produce "change fatigue" among the doctors and staff.

2. The technology needed for the PCMH is not "plug and play"; instead, its implementation is "more difficult and time consuming than originally envisioned," in part because systems aren't interoperable.

3. The amount of change required to become a PCMH "takes more time than the two years allocated to the NDP."

4. Transforming to a PCMH requires tremendous costs, in terms of dollars, time and effort, and "currently available funds and reimbursements are likely to be inadequate."

As daunting as that sounds, it might actually be worth the trouble if there is evidence that the PCMH model as currently defined (with its dozens of components) makes a difference for patients. But does it? That's the million-dollar question. The research team has collected data on the patient experience and clinical outcomes for the 36 practices in the NDP, but those reports aren't slated for publication until early 2010. Judging from the tone of the researchers' first article, it's hard to believe that the coming data will be positive.

The researchers note that for practices to become PCMHs under the current model, they need more time, more money and better technology. That could be. Or is there something amiss with the PCMH model itself? Read one view on that question from the well-known researcher Barbara Starfield, MD, MPH, in an editorial for Family Practice Management.

Posted at 02:04PM May 12, 2009 by Brandi White  |  Comments[1]