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First take: Supporting PCMH in the value-based future


The challenge for many practices is to provide PCMH without adequate funding as we wait for value-based programs to become more prevalent.

The concept of medical homes was first conceived by pediatricians in 1967. Since then, other medical disciplines such as family practice and internal medicine have come on board to support care through this concept.

The medical home is best described as a model or philosophy of primary care that is “patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety,” according to the Patient-Centered Primary Care Collaborative.

This usually results in fewer patients seen per day because more time is spent at each visit to address preventative recommendations, to coordinate care between different providers, and work with patients and their families as a team. Time and effort is also needed to address the patients who are not at the office-the portion of the iceberg below the waterline.

This population-based care is pro-active in nature and does not involve face-to-face interaction, is often uncompensated, and can account for more than 25% of the time of the clerical, mid-level and physician staff, by my account.

Several organizations provide criteria by which a practice can be recognized as a patient-centered medical home (PCMH), including the Association of Academic Health Centers, The Joint Commission, the National Committee for Quality Assurance, and the Utilization Review Accreditation Commission.

Next: Examining the challenges


The Affordable Care Act led to varying degrees of enhanced reimbursement for Medicaid and Medicare providers while multiple commercial plans also offered to increase payment to practices that qualified.

Unfortunately, these programs were not universally implemented and many are at risk of ending if not renewed by the federal and state governments. Commercial plans have been very slow in many regions to compensate adequately for the increased time and effort required for PCMH care.

Thus, the challenge for many practices is to provide PCMH care without adequate funding as we wait for value-based programs to become more prevalent. Value-based programs go beyond simple risk-sharing by focusing also on outcomes and patient satisfaction.

By joining accountable care organizations, PCMHs can leverage the infrastructure and finances of a larger group to help during the transition to a value-based payment system that benefits patients and providers alike.


Salvatore Volpe, MD, runs a solo pediatric practice in Staten Island, New York, and is a member of the Medical Economics editorial advisory board.

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