Small Practices Can Transform to Medical Homes, With Some Help
By Emily Mullin
September 25, 2012
Achieving patient-centered medical home status has become a major priority for primary care practices across the county to achieve improved patient outcomes while reducing costs.
However, attaining medical home designation is especially challenging for smaller practices.
A new study suggests that small, undersourced primary care practices – those with 10 or fewer physicians – can rapidly transform into medical homes if they have external support, including hands-on expertise in practice redesign, care management assistance, and enhanced payment.
Small practices may lack the capacity and experience needed to fully implement the medical home model, and without outside support, medical home transformation is likely to be slow and limited in scope.
To ensure access to this support, the study recommends that healthcare organizations and state policymakers consider creating a "public utility" to contract out medical home support services to physician practices. Efforts to implement the medical home model should focus in particular on electronic prescribing, referral tracking, and advanced electronic communications.
The study, “A Randomized, Controlled Trial of Implementing the Patient-Centered Medical Home Model in Solo and Small Practices,” was published in the September Journal of General Internal Medicine.
Conducted by EmblemHealth, a New York-based health insurance company, and researchers at the University of Connecticut, the study found that the majority of primary care practices in the United States are small or medium sized and not part of an integrated health system. With a nationwide focus on affordable, patient-centered care, there is growing concern about the capacity of small practices to make the transition to medical homes.
"This study will help shape the discussion of how small practices throughout the nation can make the transition to patient-centered medical homes," said EmblemHealth chief medical officer Dr. William Gillespie in a company press release.
The study recruited 18 practices for the intervention group and 14 practices for the control group. EmblemHealth contracted with consultants to advise the intervention physician group on ways to redesign their practices. EmblemHealth also contracted with nurse care managers who were embedded in the 18 intervention group practices. They provided education about developing patient care plans and coordinating care with other providers.
The 18-month study showed that small practices receiving EmblemHealth support improved significantly on standards for medical home standards. But when measured at baseline, only three of the 20 intervention practices – 15 percent – and none of the 14 control practices had achieved any level of medical home recognition. After 18 months into the study, only one intervention practice – 5 percent – had not achieved any level of medical home recognition, compared with 11 control practices, or 79 percent. In addition, intervention practices changed much more quickly during the first seven months of the trial than during the subsequent 12 months.
The intervention group received financial support from EmblemHealth that included incentive payments as they achieved benchmarks in the transition to PCMH. The 14 control group practices were compensated for providing data during the study.
While practices with EmblemHealth support significantly helped practices toward achieving medical home status, one standard – using advanced electronic communications – remained a barrier for both intervention and control practices.
The medical home model is based upon the principles advanced by the four primary care physician groups – the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and the American Osteopathic Association.