Not all medical homes created equal

Don't use the same measuring stick to judge the effectiveness of all patient-centered medical homes (PCMH), advised a policy expert and PCMH researcher, MedPage Today reported.

Instead, assess each model based on its own terms and conditions, said Asaf Bitton, M.D., of the Harvard Medical School, who chairs the clinical quality workgroup at the Commonwealth Fund's Patient-Centered Medical Home Evaluators' Collaborative. Doing so won't simplify primary care reforms into a yes-or-no issue, according to the article.

"Rather, ask the question as a community of concerned individuals and stakeholders, in what context, in what situations, with what support, with what payment incentives, with what transformation incentives does the medical home work over what time period?" Bitton said.

MedPage pointed to a September JAMA Internal Medicine study that argued against evaluating PCMHs in the same way research justifies Food and Drug Administration approval of a drug, noting the PCMH is not a pill.

"A pharmaceutical product can be manufactured with uniform specifications and delivered in a standardized manner," the study states. "The patient-centered medical home, however, is a multifaceted intervention. It involves changes in the organization, structure, processes, culture, and financial model of practice."

As healthcare organizations achieve lower costs and better care through PCMHs, the numbers and types of medical homes continue to grow. 

"Some people think they have to start from scratch but there are a lot of interesting models you can build off of and then tweak to modify to your practice or site," Sabine Nicoleau, director of Montefiore's Patient-Centered Medical Home project told FiercePracticeManagement last month in an exclusive interview.

For example, in addition to its more broadly based medical homes, Health Care Service Corporation (HCSC) this year launched a new intensive medical home program for "persistently and actionably high-risk, high-cost members."

To learn more:
- read the MedPage article
- check out the JAMA study