Medical Homes No Short Term Panacea

The American Academy of Family Physicians has been at the forefront of efforts to re-emphasize the role of primary care physicians in the health system; and has participated in development of the patient-centered medical home as a method for revitalizing primary care.  The Academy started a National Demonstration Project of the medical home concept in 2006.  The initial evaluation of the demonstration was reported in the Annals of Family Medicine, vol. 7, p. 254 (May/June 2009).

Thirty-six relatively sophisticated practices participated in the project.  The authors of the evaluation presented a largely qualitative report which focused on lessons which might be learned to date.  Their major point is that changing primary care practices to the medical home model is more difficult and expensive and takes longer than most advocates envision.  A complete reconstruction of a medical practice is needed, which is a highly disruptive event, both in daily work processes and in the revenue streams which sustain any physician practice.  Another significant concern was that the technology available is not really at a point where it easily facilitates practice transformation, largely because no single software system has all the necessary functionality and most of the software available has difficulty communicating with other software.

The concerns raised by this study are supported in a recent Journal of the American Medical Association commentary, vol. 301, p. 2038 (May 20, 2009), which noted the enthusiasm for the medical home approach, but also cautioned that it was not likely to produce short-run savings or to be easily implemented.  There is every reason to believe that the medical home if and when it is successfully operating can improve quality and the satisfaction of both patients and care providers.  But these articles correctly point out the difficulty and cost of obtaining widespread transition of primary care practices to the patient-centered medical home model.  And health reform advocates who rely on the model for significant savings do so at their own risk.