Medical home concept not well defined in 2007 legislation
Research Activities, November 2010, No. 363
Policymakers, payers, primary care doctors, and health system administrators have been buzzing about "patient-centered medical homes" in recent years. A new study finds that because the concept is not yet well defined, implementing medical homes may prove difficult. Robert Stenger, M.D., M.P.H., and Jennifer E. Devoe, M.D., D.Phil., of Oregon Health & Science University, reviewed pieces of legislation proposed in 2007 that mentioned medical homes. They also reviewed interviews conducted with key stakeholders from Oregon after health care reform legislation passed in 2007.
The authors found that one of the greatest barriers to implementing the medical home concept is lack of an operational definition. In fact, three-quarters of the enacted State bills in 2007 lacked precise language on medical homes. Additionally, States view the concept differently. For example, California's definition viewed it as a single provider or facility, while Louisiana defined it as a system of care, and Vermont saw it as a primary care practice.
During the interviews, primary care physicians and health system administrators expressed reservations about the potential for medical homes to increase their costs in light of ebbing reimbursements. Thus, they were less enthusiastic about the adoption of the medical home concept without a revamped payment structure. Payers and policymakers contemplating the medical home concept also expressed their worries about containing costs, either to protect their company's bottom line or to ensure public funds were used efficiently.
The authors suggest that current demonstration grants may be able to showcase ways to allay these parties' concerns. However, because of the lack of a common definition, these grants could end up producing a myriad of results showcasing innovative approaches that cannot be replicated or that stymie the medical home concept altogether. This study was funded in part by the Agency for Healthcare Research and Quality (HS14645 and HS16181).
See "Policy challenges in building the medical home: Do we have a shared blueprint?" by Drs. Stenger and DeVoe in the May/June 2010 Journal of the American Board of Family Medicine 23(3), pp. 384-392.