The National Committee for Quality Assurance (NCQA) published this discussion paper on the future of the patient-centered medical home (PCMH) in 2014, as it announced revisions to its PCMH recognition standards. The paper includes a thoughtful assessment of the significant progress towards establishing medical homes, as well as acknowledging challenges to be addressed in its own recognition standards and processes. For example, while over 7,000 practices have been recognized by NCQA as PCMHs, that is only 10 percent of primary care practices in the U.S. And while a growing body of evidence has documented PCMHs’ many benefits, including better quality, patient experience, continuity, prevention and disease management, lower costs from reduced emergency department visits and hospital admissions – other studies of PCMHs have had equivocal results.
According to the paper:
Those who are may be on steep learning curves, or lack the capabilities, commitment and resources to sustain transformation. PCMH transformation is not easy and requires a long-term commitment from every team member and a significant financial investment. Practices may face technological or legal challenges with electronic access privacy and liability. Coordination with community services, public health, dental, post-acute and other settings is minimal. Linking with behavioral care is particularly challenging yet critical because many with chronic illness also have behavioral co-morbidities. Payments and other supports vary widely among insurers and may not be sufficient, especially for non-face-to-face and team-based services not traditionally covered. Also, most patients are unaware of PCMHs. Focus groups with PCMH patients show they are aware of better access and coordination, but not the PCMH name. Those not in PCMHs often doubt such care is even possible.
The paper also directly addresses criticisms of NCQA’s PCMH recognition standards and process, for focusing on practice structure rather than outcomes, its cost, and its frequency.