Patient-Centered Medical Home Among Small Urban Practices Serving Low-Income and Disadvantaged Patients

Carolyn A. Berry; Tod Mijanovich; Stephanie Albert; Chloe H. Winther; Margaret M. Paul; Mandy Smith Ryan; Colleen McCullough; Sarah C. Shih

doi:10.1370/afm.1491

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Complementary Federal and Local Programs
Julian W Brunner

Published on: 02 July 2013
Opening doors for solo and small practices
L. Gordon Moore

Published on: 11 June 2013

Published on: (2 July 2013)
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Complementary Federal and Local Programs
Julian W Brunner, Senior Research Associate
These findings are an excellent example of an array of public programs complementing one another to bring about patient-centered care:
1) All of the practices in the study benefited from a city agency with years of experience helping small practices use digital tools to improve the quality of care they deliver;
2) the vast majority of these practices likely received or applied for federal incentives fo...
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These findings are an excellent example of an array of public programs complementing one another to bring about patient-centered care:
1) All of the practices in the study benefited from a city agency with years of experience helping small practices use digital tools to improve the quality of care they deliver;
2) the vast majority of these practices likely received or applied for federal incentives for the meaningful use of an EHR, which require several aspects of patient-centered care;
3) over two thirds of the practices benefited from NCQA's PCMH certification process, having at least learned about the goals of PCMH, and in many cases having received incentives to be recognized as medical homes.
This cohesive fabric of public support is no accident. In its 2011 Patient-Practice Connections - Patient Centered Medical Home (PPC-PCMH) standards, NCQA worked to align its PCMH recognition program with ONC's incentives for meaningful use of EHRs. Before federal meaningful use incentives, PCIP helped practices qualify for state Medicaid incentives for PCMH recognition. And, since federal incentives for EHR use became available, one of PCIP's key services has been its work as a "regional extension center," helping practices qualify for those federal incentives, and use information systems to improving population health.
It's hard to overstate how difficult practice transformation can be, but the complementarity of all three programs seems to have made it a reality in these practices.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (11 June 2013)
Page navigation anchor for Opening doors for solo and small practices
Opening doors for solo and small practices
L. Gordon Moore, Chief Medical Officer
Berry and colleagues uncovered a great deal of capacity for effective primary care in solo and small practices. This is not likely to come as a surprise to the public as the attributes of small practices are often described in positive terms. [Bechtel 2010] The surprise is likely to come from those who have mistaken the form for the function of high quality care.
Primary care is a set of cardinal functions: "Fi...
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Berry and colleagues uncovered a great deal of capacity for effective primary care in solo and small practices. This is not likely to come as a surprise to the public as the attributes of small practices are often described in positive terms. [Bechtel 2010] The surprise is likely to come from those who have mistaken the form for the function of high quality care.
Primary care is a set of cardinal functions: "First contact care, which requires accessibility and responsibility for reducing unnecessary specialist care, Person-focused care over time delivered by the patient's chosen physician, who assumes responsibility over long periods of time for all health care, Comprehensiveness of care, and Coordination of care when people have to go elsewhere for problems outside the competence of the primary care practitioner." [Starfield 2009]
If a goal is excellence in diabetes education, why stipulate a diabetes educator until we have proven that the only effective pathway? [Further, if the goal is excellence in education, why are we not using patient reported outcome measures as the gold standard?]
We spend too much of our time, money and intellectual capital chasing minutia while missing the essence of good primary care. Using a strategy that fit the goals rather than the form, Berry et al had the simple notion of asking the PCPs what they might be doing. The results are telling: more than we think.
Solo and small practices face daunting and needless hurdles to participate in many of the programs developed to help improve primary care delivery in the U.S. Participation is needlessly complicated, onerous, and costly.
Through an emphasis more on outcomes than process, on desired function rather than form, with meaningful support rather than hurdles, solo and small practices can engage in work that brings them closer to the ideal of truly patient-centered health care.
L Gordon Moore MD
Bechtel, C., and D. L. Ness. "If You Build It, Will They Come? Designing Truly Patient-Centered Health Care." Health Affairs 29, no. 5 (May 3, 2010): 914-920. doi:10.1377/hlthaff.2010.0305.
Starfield, B. "Family Medicine Should Shape Reform, Not Vice Versa." Family Practice Management (May 28, 2009). http://www.aafp.org/online/en/home/publications/journals/fpm/opinion.html.
Competing interests: None declared
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Competing Interests: None declared.