Understanding the Role of the Patient-Centered Medical Home is Building a Strong Primary Care Foundation in the U.S.

Abstract

It is generally agreed that there is much room for improvement in the U.S. healthcare system. In international comparisons, health care in the U.S. is consistently the most expensive and the U.S. lags other western industrialized countries in broad measures of health, such as morbidity and mortality. The Triple Aim goals for the improvement of U.S. healthcare outlined by the Institute for Healthcare Improvement (IHI) in 2008 continue to be widely embraced today – to improve the experience of care, improve the health of populations and to lower the per capita cost of care. To achieve these aims, the need for an “integrator” accountable for the achievement of all three aims on behalf of a defined population was recommended. One of the primary roles of the integrator is the redesign of primary care. Primary Care has long been regarded as a critical component of improving the healthcare system. In recent years, the Patient-Centered Medical Home (Medical Home) has been the favored model to return primary care to a more prominent and impactful role in the overall health care system. Using data from a commercial health plan Medical Home program in a regional geographic setting, this dissertation provides insights into the role and impact of the Medical Home in fulfilling the aspirational goals for U.S. primary care. This study examined basic differences between Medical Home and non-Medical Home practices, whether Medical Home implementation is associated with differences in physician practice patterns, and whether ownership of Medical Homes by hospitals or healthcare systems is associated with differences in total cost of care or the utilization of high-cost services. This study finds that small, rural primary care practices are under-represented among Medical Homes, that physicians practicing in Medical Homes provide care that is more consistent with high quality primary care than physicians practicing in non-Medical Homes, and that Medical Homes owned by hospitals or healthcare systems are associated with a higher total cost of care and higher rates of inpatient hospital admissions. The focus on the Medical Home model has provided an important vehicle for the evolution of primary care over the last ten years. It is an opportune time in this ongoing evolution for policy makers, health plans and healthcare purchasers to shift the conversation from a focus on the Medical Home to how to support high quality primary care in a consistent and sustainable manner across all primary care practices, regardless of practice size, geography, or ownership. Payers, including government purchasers and commercial health plans, are uniquely positioned to support this shift in the form of the “integrator” described as necessary to the fulfillment of the Triple Aim goals.