Advertisement

Physician Perspectives on Medical Home Recognition for Practice Transformation for Children

Published:December 16, 2015DOI:https://doi.org/10.1016/j.acap.2015.12.001

      Abstract

      Objective

      To examine child-serving physicians' perspectives on motivations for and support for practices in seeking patient-centered medical home (PCMH) recognition, changes in practice infrastructure, and care processes before and after recognition, and perceived benefits and challenges of functioning as a PCMH for the children they serve, especially children with special health care needs.

      Methods

      Semistructured interviews with 20 pediatricians and family physicians at practices that achieved National Committee for Quality Assurance level 3 PCMH recognition before 2011. We coded notes and identified themes using an iterative process and pattern recognition analysis.

      Results

      Physicians reported being motivated to seek PCMH recognition by a combination of altruistic and practical goals. Most said recognition acknowledged existing practice characteristics, but encouraged ongoing, and in some cases substantial, transformation. Although many physicians said recognition helped practices improve financial arrangements with payers and participate in quality initiatives, most physicians could not assess the specific benefits of recognition on patients' use of services or health outcomes. Challenges for practices in providing care for children included managing additional physician responsibilities, communicating with other providers and health systems, and building sustainable care coordination procedures.

      Conclusions

      PCMH recognition can be valuable to practices as a public acknowledgement to payers and patients that certain processes are in place, and can also catalyze new and continued transformation. Programs and policies seeking to transform primary care for children should leverage physicians' motivations and find mechanisms to build practices' capacity for care management systems and linkages with the medical neighborhood.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Peikes D.
        • Zutshi A.
        • Genevro J.L.
        • et al.
        Early evaluations of the medical home: building on a promising start.
        Am J Manag Care. 2012; 18: 105-116
        • Kilo C.M.
        • Wasson J.H.
        Practice redesign and the patient-centered medical home: history, promises, and challenges.
        Health Aff (Millwood). 2010; 29: 773-778
        • Sia C.
        • Tonniges T.F.
        • Osterhus E.
        • et al.
        History of the medical home concept.
        Pediatrics. 2004; 113: 1473-1478
        • Reid R.J.
        • Fishman P.A.
        • Yu O.
        • et al.
        Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation.
        Am J Manag Care. 2009; 15: e71-e87
        • Reid R.J.
        • Coleman K.
        • Johnson E.A.
        • et al.
        The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers.
        Health Aff (Millwood). 2010; 29: 835-843
        • Solberg L.I.
        • Asche S.E.
        • Fontaine P.
        • et al.
        Relationship of clinical medical home scores to quality and patient experience.
        J Ambul Care Manage. 2011; 34: 57-66
        • Christensen A.L.
        • Zickafoose J.S.
        • Natzke B.
        • et al.
        Associations between practice-reported medical homeness and health care utilization among publicly insured children.
        Acad Pediatr. 2015; 15: 267-274
        • Rittenhouse D.R.
        • Schmidt L.A.
        • Wu K.J.
        • et al.
        The post-Katrina conversion of clinics in New Orleans to medical homes shows change is possible, but hard to sustain.
        Health Aff (Millwood). 2012; 31: 1729-1738
        • American Academy of Family Physicians
        • American Academy of Pediatrics
        • American College of Physicians
        • American Osteopathic Association
        Joint Principles of the Patient-Centered Medical Home.
        2007 (Available at:) (Accessed March 29, 2013)
      1. Patient-Centered Primary Care Collaborative. The Medical Home: Results and Evidence. Available at: https://www.pcpcc.org/results-evidence. Accessed April 30, 2012.

        • Van Dyck P.C.
        • Kogan M.D.
        • McPherson M.
        • et al.
        Prevalence and characteristics of children with special health care needs.
        Arch Pediatr Adolesc Med. 2004; 158: 884-890
        • Strickland B.B.
        • Singh G.K.
        • Kogan M.D.
        • et al.
        Access to medical home: new findings from the 2005-2006 National Survey of Children with Special Needs.
        Pediatrics. 2009; 123: 996-1004
        • Homer C.J.
        • Klatka K.
        • Romm D.
        • et al.
        A review of the evidence for the medical home for children with special health care needs.
        Pediatrics. 2008; 122: e922-e937
        • Cooley W.C.
        • McAllister J.W.
        • Sherrieb K.
        • et al.
        Improved outcomes associated with medical home implementation in pediatric primary care.
        Pediatrics. 2009; 124: 358-364
        • Mosquera R.A.
        • Avritscher E.B.
        • Samuels C.L.
        • et al.
        Effect of an enhanced medical home on serious illness and cost of care among high-risk children with chronic illness a randomized clinical trial.
        JAMA. 2014; 312: 2640-2648
      2. NCQA. 2008 Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) Program. Available at: https://www.ncqa.org/Portals/0/Programs/Recognition/PPC-PCMH%202008%20vs%20PCMH%202011Crosswalk%20FINAL.pdf. Accessed June 25, 2012.

        • Takach M.
        Reinventing Medicaid: state innovations to qualify and pay for patient-centered medical homes show promising results.
        Health Aff (Millwood). 2011; 30: 1325-1334
      3. Stewart KA, Zickafoose JS, Wu B, et al. Association Between NCQA Patient-Centered Medical Home Recognition for Primary Care Practices and Quality of Care for Children with Disabilities and Special Health Care Needs (No. 0ba6ce2e27774094b3a5c15564bc03f3). Mathematica Policy Research. Available at: http://aspe.hhs.gov/daltcp/reports/2014/ChildDisV3.pdf. Accessed August 12, 2015.

      4. Centers for Medicare and Medicaid Services. Medicaid Analytic eXtract (MAX) General Information. Available at: https://www.cms.gov/research-statistics-data-and-systems/computer-data-and-systems/medicaiddatasourcesgeninfo/maxgeneralinformation.html. Accessed October 14, 2012.

      5. Kronick RG, Bella M, Gilmer TP. The faces of Medicaid III: refining the portrait of people with multiple chronic conditions. Center for Health Care Strategies, Inc, October 2009. Available at: http://www.chcs.org/media/Faces_of_Medicaid_III.pdf. Accessed June 26, 2012.

        • Patton M.
        Qualitative Evaluation and Research Methods.
        3rd ed. Sage, Newbury Park, Calif2002
        • Barbour R.S.
        Checklist for improving rigour in qualitative research: a case of the tail wagging the dog?.
        Br Med J. 2001; 322: 1115-1117
        • Decamp L.R.
        • Kieffer E.
        • Zickafoose J.S.
        • et al.
        The voices of limited English proficiency Latina mothers on pediatric primary care: lessons for the medical home.
        Matern Child Health J. 2013; 17: 95-109
        • Boyatzis R.
        Transforming Qualitative Information: Thematic Analysis and Code Development.
        Sage, Thousand Oaks, Calif1998
        • Nutting P.A.
        • Crabtree B.F.
        • Miller W.L.
        • et al.
        Transforming physician practices to patient-centered medical homes: lessons from the national demonstration project.
        Health Aff (Millwood). 2011; 30: 439-445
        • Taylor E.F.
        • Machta R.M.
        • Meyers D.S.
        • et al.
        Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.
        Ann Fam Med. 2013; 11: 80-83
        • Bodenheimer T.
        • Sinsky C.
        From triple to quadruple aim: care of the patient requires care of the provider.
        Ann Fam Med. 2014; 12: 573-576