Recently, the National Committe for Quality Assurance confirmed what many of us suspected: there's been a dramatic increase in the number of primary-care clinicians who are part of patient-centered medical homes. The NCQA counted 7,700 at the end of 2010 a 3,400% increase since 2008.
While that's good news for nearly every part of healthcare delivery, the bad news is that there could be as many as 325,000 primary-care physicians who are not NCQA certified. That means there are a whole lot of (medical) homeless Americans.
As I consider friends and family living throughout the United States, I can't think of one of them who's actually in a medical home. I can think of several sick and aging aunts and uncles who need to be in one.
Clearly, there are PCPs who are coordinating care, focusing on chronically ill patients and using electronic medical records to improve the health of their patients, without going to the expense of the NCQA designation. And there are thousands of PCPs who won't be part of a PCMH because their practices are too small or they don't have the attention of a payer to help fund it.
The American Academy of Family Physicians tested this hypothesis and recruited 36 mostly, small independent practices to transform into PCMHs in 2006. Their conclusions are outlined in a recent article in The journal Health Affairs. While the study says that highly motivated practices can implement many of the components of a PCMH, it takes time to do so more than the two years in the demonstration.
The practices succeeded in changing processes, such as same-day appointments and improved patient access to lab records. More difficult was changing the very model in which PCPs practice one doctor and one patient in an examining room. New ways of thinking about primary care will need to emphasize working within more collaborative teams and using multiple channels of care, such as telemedicine, e-visits and group visits, the study says.
So not only will it take time, the medical home model may require physicians to change the way they approach medicine. The cynic in me thinks that might take at least a generation.
Payers are pouring unprecedented bonuses into incentives for primary-care practices to become PCMHs. The movement represents a good start to slowing down medical cost inflation and coordinating care. If enough data becomes available proving the worth of medical homes, look for insurers and government to step up incentives to pull the larger universe of PCPs into medical homes.