Patient-Centered Medical Home Deserves Rigorous Evaluation

John Marcille

It seems to me that the combination of the steep escalation of health care costs and extensive effects — at this point we can only guess at how wrenching they will be — of the Patient Protection and Affordable Care Act and other reform measures are promoting a frenzy of efforts to remake our payment and delivery systems.

To some it might feel like walking in mud, but it’s a frenzy compared with the usual pace of health care change. And one of the leading areas of change is the widespread interest in the patient-centered medical home (PCMH). Contributing Editor John Carroll does a fine job of giving us a look at where this widely heralded movement is today.

Now, I have always been a tad suspicious that the concept of the PCMH was developed more for the benefit of the primary care doctors than for patients or health plans or payers, but at the same time, the concept seems to make sense for patients and plans and the primary care docs, if not for hospitals and specialists. So motives aside, testing this out seems the right thing to do.

Yet, as John implies in his article, the evidence is still not sufficient for widespread adoption. Group Health Cooperative, for example, reports getting a 50 percent return on its investment in the PCMH and a more-than-$10 decrease in PMPM expenditures in the single location where it tested the concept. But Group Health is highly integrated and most health care in the nation is not. Plus there was no randomized control group and the gains, John reports, did not reach statistical significance. Further, Group Health is expanding the program to its other clinics.

Still, I have no doubt that in one way or another, many of the attributes of the PCMH will be found in most medical practices within the next five to ten years.