Patient-centered medical homes are a long-term investment

The theory that patient-centered medical homes can improve quality and reduce costs may have hit a bump in the road with the results of a new study published in the journal Health Affairs.

The study evaluated the first national medical home demonstration, which ran from 2006 to 2008 and involved 36 practices, concluding that creating medical homes can be lengthy and complex. The demonstration, launched by the American Academy of Family Physicians, involved small, independent physician practices aiming to transform themselves into patient-centered medical homes.

To become patient-centered medical homes, the practices installed electronic record-keeping and expanded patient access with longer hours and open scheduling. They also began incorporating preventive care and provided patients treatment with teams of nurses, doctors and assistants who worked together.

The project design had several limitations, most relevant to health payers is that it failed to include changes in physician reimbursement, although practices generally anticipated payment reform would eventually favor the changes they were making.

The bottom line is that creating patient-centered medical homes required a lot of time. It is a "long-term proposition and much more than a series of incremental improvements made over two years," the study authors wrote. Development of meaningful care teams also implies major changes to the ways individuals and groups within practices view their roles and work together. Accomplishing these dramatic changes requires ongoing and relentless dedication to improvement that challenges even the most motivated practice.

So, instead of focusing on individual practices and a "just do it" approach, the study authors recommend medical homes be conceptualized and developed as part of integrated healthcare neighborhoods requiring long-term commitments and perhaps three to five years of external assistance. If health payers want to facilitate this transformation, they must synchronize reimbursement reform with practice redesign.

However, the study results shouldn't scare off health insurers who are interested in helping establish such patient-centered homes. Many industry experts believe medical homes are a vital step in creating a better-performing healthcare system. Indeed, highly motivated practices could potentially implement many of the model components within two years. Numerous other pilot pojects have resulted in success, including better outcomes, reduced mortality, fewer preventable hospital admissions for patients with chronic diseases, and lower utilization. But, based on this study, it seems patience and specific, long-term goals must first be realized before those successes can be achieved. - Dina