Changes in primary care medical practices resulting from medical home transformation

Background: Evolution of outpatient practice into a model that offers primary care that is accessible, continuous, coordinated, and based on team care, is an objective for health care reform.  This model is referred to as the patient centered medical home model (medical home).  The structure and process changes required for transformation to the medical home are well described and expert groups are in place to bestow recognition.  Support for this expanded model of care is intended to come from expanded payment.  Since small practices are responsible for care of large proportions of the population, understanding the kind of transformation they make and the financial barriers they face is crucial to the success of the model.  Our objectives were to identify the characteristics and the cost of the transformation for a pilot sample of small practices that achieved National Committee of Quality Assurance (NCQA) recognition as medical homes.  This abstract will address the first objective--the characteristics of the transformation.     

Methods: We utilized a survey and interviews to elicit the practice level activities undertaken for transformation.  The study sample included 11 small to medium sized practices (less than 10 FTE providers) in southeastern Pennsylvania that had all achieved NCQA recognition as medical homes.  Nine of the practices shared a common link in that they participated in the PA Chronic Care Initiative designed to facilitate practice transformation and NCQA recognition. The remaining 2 practices, also achieved NCQA recognition without participation in the statewide program.  

Results:  Of the 11 practices, 4 currently have the highest level of NCQA recognition (Level III) with the remaining practices recognized as either Level II (4) or Level I (3). The practices differ significantly from each other in terms of workforce, practice type, population served, and method of reimbursement.  All of the practices installed electronic medical records (EMR) during transformation and indicated that policy and process changes were made possible due to EMR implementation. Changes implemented by a majority included imbedding evidence based guidelines into the decision-making process (9/11), expanding the use of internal data to measure quality (9/11), improvements in patient access and scheduling (8/11), and an increase in shared decision-making capability (7/11).

Conclusions: The practices made and sustained changes in structures and processes and utilized many similar activities in achieving NCQA recognition. The next phase of the project will collect and examine the cost of these changes to the practices.