Recent criticism of the Patient-Centered Medical Home (PCMH) is based on the perceived lack of significant findings from a few CMS demonstrations including one of the Federally Qualified Health Centers Advanced Primary Care Practice, the Multi-payer Advanced Primary Care Practice and the Comprehensive Primary Care Initiative. This provides us with an opportunity to highlight limitations in these demos that likely account for many of the findings reported.
The three demonstrations looked at PCMH programs for up to three years during which practices were likely being assessed while they were still building PCMH attributes.
Three years is insufficient for most practices to transform, mature, and optimize the PCMH attributes into daily operations. This is also insufficient time to demonstrate the longer-term clinical benefits of good preventative care which typically adds costs when proper screening and outreach strategies are implemented.
NCQA maintains that practices and programs adopting the PCMH model need at least 5 years to produce significant quality and cost benefits.
Another shortcoming of these studies is that federal programs permitted practices to be designated as a PCMH without requiring much more than attestation to the PCMH attributes. We believe that the work of NCQA PCMH recognition makes a difference in performance. With the 2017 update, NCQA recognition means that practices need to meet all of the required elements for initial recognition and on an annual basis demonstrate that they continue to improve and abide by the core principles.
Moving Forward with PCMH
Is there work to be done to ensure PCMHs operate to their fullest potential? Absolutely, and we will continue our mission to measure and improve the program every step of the way. Investment in primary care remains a critical need. This model is designed to help ensure that public and private investments lead to better access, improved care coordination, engagement of patients and families, effective population health strategies, and appropriate use of technology to support communication, documentation, information-sharing, and decision-making. While researchers continue to evaluate this complex intervention, let’s continue to push so that these attributes of health care become the rule – not the exception.