Early findings from the Massachusetts patient centered medical home initiative

Background: The Massachusetts Patient-Centered Medical Home Initiative (MA-PCMHI) is the Executive Office of Health and Human Services' public (Medicaid)/private cooperative effort to promote adoption of the patient centered medical home (PCMH) model. Since the MA-PCMHI's inception in 2010, the Center for Health Policy and Research at UMass Medical School has evaluated the MA-PCMHI's intervention with a diverse group of 45 primary care practices. The full evaluation seeks to measure select outcomes, including: mastery of Patient Centered Medical Home (PCMH) core competencies; improvements in patient experiences; and clinical impact - relative to non-participating practices. The evaluation's qualitative study aims to describe the MA-PCMHI primary care practices' early experiences with adopting the PCMH model and the challenges faced. In this session, we will present the qualitative study's findings at MA-PCMHI mid-point. Methods: The qualitative study uses a descriptive design with multiple data sources. Three rounds of in-depth, semi-structured individual interviews and focus groups with the practices' Medical Home Facilitators (MHF) were conducted over 14 months. The 45 practices' MA-PCMHI applications were collected and field notes taken at 5 MA-PCMHI learning sessions. Using an analysis plan framed by the study aims, PCMH competencies, organizational change theory and evidence from other PCMH initiatives, data were coded and analyzed. Results: Over half of practices selected for the MA-PCMHI are Community Health Center affiliates (54%) and have multiple practice specialties (56%). Most are located in urban areas (89%). The 45 practices include independent physician practices as well as safety net hospital affiliates. Practices' experience with health information technology varied widely at project inception. The qualitative analyses produced four themes: (1) each practice has a unique medical home adoption experience which requires a time span sufficient for organizational and personal transformation; (2) practice leaders' consistent support is necessary for PCMH adoption; (3) information technology shortcomings impede PCMH adoption as does (4) generating revenue via fee-for-service reimbursement. A practice adopts PCMH principles and practices at its own pace, which may exceed the time span of a demonstration project, for example the MA-PCMHI's three-year period. Therefore, it is important to allow sufficient time, facilitate the adoption process and monitor the practices' progress as well as the expected clinical and cost outcomes. The MA-PCMHI has worked to monitor practices' transformation progress, sustain high levels of support from the practice organizations' executive leaders (e.g. CEOs) and enhance information technology systems' functioning to support PCMH model care.