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AJMC Study Looks at the Shaky Foundation of the Patient-centered Medical Home

The patient-centered medical home has been proposed as a solution to the challenges facing primary care, but there are several concerns over whether this approach is feasible.

This article originally appeared in the June 2010 issue of the American Journal of Managed Care, part of the HCPLive network.

The patient-centered medical home (PCMH) is viewed as an idea whose time has come. In theory, the PCMH enables better primary care centered on a more defined relationship between primary care physicians (PCPs) and patients, team-based primary care service delivery, enhanced care coordination and access to primary care, and improved quality through the use of disease registries and health information technology. Integral to the PCMH model is added payment for PCPs to help compensate them for enhanced care coordination, as well as to fund the personnel and technology-related investments needed in the practice to do medical home—type care.

Proponents assert that the PCMH makes sense for a healthcare system that is fragmented, impersonal, and overly focused on high-cost specialty care. With demonstration projects under way nationally, they hope that implementation of the model can show enough quality improvement and cost savings to ensure its long-term survival.

But something important is missing in the current medical home debate. Little serious attention is being paid to whether implementation of the medical home model can help solve several key problems already transforming our current primary care system, or if the model will succumb to these problems despite evidence that it works.

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