Structural Capabilities in Small and Medium-Sized Patient-Centered Medical Homes

The American Journal of Managed Care article Structural Capabilities in Small and Medium-Sized Patient-Centered Medical Homes describes the first study to look at structural capabilities and change over time in small- to medium-sized primary care practices participating in Patient-Centered Medical Homes (PCMH) pilots.  The authors examined the structural capabilities of 30 pilot projects and change over time in five Rhode Island pilot projects. Their findings show that small- and medium-size primary care practices are able to achieve a high level of medical home capability.

The study used the National Committee for Quality Assurance’s Physician Practice Connections—Patient-Centered Medical Home (PPC-PCMH) accreditation survey data to determine that:

  • On average, practices earned a total score of 73 points (out of 100) for their structural capabilities at baseline.
  • High- and low-performing practices differed most in their achievement on electronic prescribing, patient self-management, and care management standards.
  • Rhode Island practices had an average score of 42 points at baseline and 90 points after 24 months.
  • Building structural capabilities requires attention to payment reform, implementation and cultural change.

Approaches that facilitated PCMH achievement included payment incentives, “transformation coaches,” learning collaboratives, and data availability to support performance management and quality improvement.  Conditions that hindered PCMH achievement included the extent of transformation required, technology shortcomings, slow cultural change, change fatigue, and lack of broader payment reform.

Small- and medium-sized practices, currently working on achieving PCMH accreditation should be encouraged by these findings. Providers will want to review the description of the approaches that facilitate and hinder PCMH achievement to determine if any changes are needed for their own practices.

Click here to read the entire AJMC article.

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