Because good primary care is believed to be a key to overall good quality of health care, numerous ideas have been advanced to improve the delivery of primary care. The most prominent one is the medical home concept, which is being tested in numerous pilot projects. Two new publications, one from the Deloitte Center for Health Solutions, and one published in Health Affairs and written by Robert Wood Johnson researchers, look at the status of the concept and opportunities and challenges for its adoption. (Deloitte Brief) (Health Affairs Brief)
The Health Affairs article reviews the common standards used to define a medical home and describes a number of the pilot efforts, including those by Medicare and Medicaid programs. It notes that most of the experience to date indicates that a massive effort is required to transform primary care practices to medical homes. There are many questions as well about the extent to which payment reform is needed as an adjunct to the adoption of the medical home. Evidence to date suggests that cost-savings will occur, primarily in fewer hospitalizations, but it is not clear what the overall net effects are when the costs of implementing and maintaining a medical home are fully accounted for.
Deloitte’s brief also reviews general features of a medical home and gives a more expanded list of pilot programs, summarizing both the nature of the projects as well as preliminary results from some of the projects. Deloitte’s key takeaways include: with significant investment a PCMH can yield results in quality and cost savings; investment in systems like EHRs are critical; physician buy-in is important; one-size may not fit all and identifying an appropriate incentive and payment model can also facilitate successful implementation. These publications don’t break new ground but they do provide good overviews of the concept and its progress.