The ugly truth is that health care is often inefficient, costly, and does not meet the needs of its principal constituent—the patient. This realization has led many physicians and health systems to enthusiastically turn to a new model for delivering primary care, the patient-centered medical home. The patient-centered medical home is a simple idea. It reorganizes care around the needs of the patient, emphasizing coordinated, accessible, and efficient care. In short, it reimagines the health care delivery system in the best image of itself.
Becoming a medical home has been a rather straightforward (though at times costly) process for most primary care practices. According to the NCQA, the organization that certifies most medical homes in this country, practices must invest in infrastructure to support this new delivery model—by using patient registries to easily identify patients who might benefit from coordinated care, increasing doctors’ accessibility for their patients through extended hours, same-day appointments, or secure messaging, and making other changes to the structure of delivery to support the goals of the medical home. Physician practices often make these changes in exchange for increased payments, which may also be tied to metrics to ensure that high-quality care is delivered.
The idea seems too good to not work. Yet the evidence to date is disappointing. Studies often find that when practices adopt the patient-centered medical home there is little change in the quality or costs of care.