Currently Viewing:
The American Journal of Managed Care June 2014
Comparison Between Guideline-Preferred and Nonpreferred First-Line HIV Antiretroviral Therapy
Stephen S. Johnston, MA; Timothy Juday, PhD; Amanda M. Farr, MPH; Bong-Chul Chu, PhD; and Tony Hebden, PhD
The Value of Specialty Pharmaceuticals - A Systematic Review
Martin Zalesak, MD, PhD; Joyce S. Greenbaum, BA; Joshua T. Cohen, PhD; Fotios Kokkotos, PhD; Adam Lustig, MS; Peter J. Neumann, ScD; Daryl Pritchard, PhD; Jeffrey Stewart, BA; and Robert W. Dubois, MD
Health Insurance and Breast-Conserving Surgery With Radiation Treatment
Askal Ayalew Ali, MA; Hong Xiao, PhD; and Gebre-Egziabher Kiros, PhD
Currently Reading
Patient-Centered Medical Home and Quality Measurement in Small Practices
Jason J. Wang, PhD; Chloe H. Winther, BA; Jisung Cha, PhD; Colleen M. McCullough, MPA; Amanda S. Parsons, MD, MBA; Jesse Singer, DO, MPH; and Sarah C. Shih, MPH
Novel Predictive Models for Metabolic Syndrome Risk: A "Big Data" Analytic Approach
Gregory B. Steinberg, MB, BCh; Bruce W. Church, PhD; Carol J. McCall, FSA, MAAA; Adam B. Scott, MBA; and Brian P. Kalis, MBA
Primary Care Diabetes Bundle Management: 3-Year Outcomes for Microvascular and Macrovascular Events
Frederick J. Bloom Jr, MD; Xiaowei Yan, PhD; Walter F. Stewart, PhD; Thomas R. Graf, MD; Tammy Anderer, PhD; Duane E. Davis, MD; Steven B. Pierdon, MD; James Pitcavage, MS; and Glenn D. Steele Jr, MD
Association of Electronic Health Records With Cost Savings in a National Sample
Abby Swanson Kazley, PhD; Annie N. Simpson, PhD; Kit N. Simpson, DPH; and Ron Teufel, MD
Learning About 30-Day Readmissions From Patients With Repeated Hospitalizations
Jeanne T. Black, PhD, MBA
Removing a Constraint on Hospital Utilization: A Natural Experiment in Maryland
Noah S. Kalman, MD; Bradley G. Hammill, MS; Robert B. Murray, MA, MBA; and Kevin A. Schulman, MD
Using Clinically Nuanced Cost Sharing to Enhance Consumer Access to Specialty Medications
Jason Buxbaum, MHSA; Jonas de Souza, MD; and A. Mark Fendrick, MD
Real-World Impact of Comparative Effectiveness Research Findings on Clinical Practice
Teresa B. Gibson, PhD; Emily D. Ehrlich, MPH; Jennifer Graff, PharmD; Robert Dubois, MD; Amanda M. Farr, MPH; Michael Chernew, PhD; and A. Mark Fendrick, MD
A Systematic Review of Value-Based Insurance Design in Chronic Diseases
Karen L. Tang, MD; Lianne Barnieh, PhD; Bikaramjit Mann, MD; Fiona Clement, PhD; David J.T. Campbell, MD, MSc; Brenda R. Hemmelgarn, MD, PhD; Marcello Tonelli, MD, SM; Diane Lorenzetti, MLS; and Braden J. Manns, MD, MSc

Patient-Centered Medical Home and Quality Measurement in Small Practices

Jason J. Wang, PhD; Chloe H. Winther, BA; Jisung Cha, PhD; Colleen M. McCullough, MPA; Amanda S. Parsons, MD, MBA; Jesse Singer, DO, MPH; and Sarah C. Shih, MPH
Small practices with NCQA patient-centered medical home recognition perform better on quality measures, especially those related to chronic conditions.
Whether practices that became PCMH-recognized already had higher performance on quality measures or were able to improve their performance on quality measures through PCMH transformation, our findings suggest that these practices have higher rates of quality measurement in 7 areas of preventive care. As is currently under CMS consideration, PCMH recognition may serve as a marker to consumers in helping them select high-quality practices, and to payers who are looking to differentiate among their network clinicians.30 However, better care and health could be achieved if all practices continued to improve over time. Efforts to further encourage all practices to demonstrate improvement on preventive care for patients with chronic conditions could be supported by PCMH transformation. Further rewards for practices and areas of care that may have been reaching a ceiling, such as smoking status recorded or BMI recorded, would be wasted resources that could be used to assist lower performers on areas of care with direct impact on improved population health. Finally, further monitoring over time will determine if PCMH recognition continues to produce positive health outcomes for patients with chronic conditions.

Author Affiliations: New York City Department of Health and Mental Hygiene, Primary Care Information Project, Queens, NY (JJW, CHW, JC, CMM, ASP, JS, SCS).

Source of Funding: New York City Tax Levy and the Agency for Healthcare Research and Quality R18 HS019164.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (JJW, CHW, JS, SCS); acquisition of data (JJW, JC, CMM, SCS); analysis and interpretation of data (JJW, JC, CMM); drafting of the manuscript (JJW, CHW, CMM, ASP, SCS); critical revision of the manuscript for important intellectual content (JJW, CHW, CMM, ASP, SCS); statistical analysis (JJW, JC); provision of study materials or patients (AP, JS); obtaining funding (ASP); administrative, technical, or logistic support (JJW, CHW, JS, SCS); supervision (JJW, JS, SCS).

Address correspondence to: Jason J. Wang, PhD, New York City Department of Health and Mental Hygiene, Primary Care Information Project, 42-09 28th St, 12th Fl, Queens, NY 11101. E-mail: jwang5@health.
1. Wagner EH, Coleman K, Reid RJ, Phillips K, Abrams MK, Sugarman JR. The changes involved in patient-centered medical home transformation. Prim Care. 2012;39(2):241-259.

2. Maeng DD, Graham J, Graf TR, et al. Reducing long-term cost by transforming primary care: evidence from Geisinger’s medical home model. Am J Manag Care. 2012;18(3):149-155.

3. Reid RJ, Fishman PA, Yu O, et al. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Manag Care. 2009; 15(9):e71-e87.

4. Takach M. Reinventing Medicaid: state innovations to qualify and pay for patient-centered medical homes show promising results. Health Aff (Millwood). 2011;30(7):1325-1334.

5. Friedberg MW, Coltin KL, Safran DG, Dresser M, Zaslavsky AM, Schneider EC. Associations between structural capabilities of primary care practices and performance on selected quality measures. Ann Intern Med. 2009;151(7):456-63.

6. Kaye N, Buxbaum J, Takach M; the Commonwealth Fund National Academy for State Health Policy. Building Medical Homes: Lessons from Eight States with Emerging Programs. http://www.commonwealthfund. org/~/media/Files/Publications/Fund%20Report/2011/ Dec/1569_Kaye_building_medical_homes_v2.pdf. Published December 2011. Accessed May 18, 2012.

7. Nutting PA, Crabtree BF, Stewart EE, et al. Effect of facilitation on practice outcomes in the National Demonstration Project model of the patient-centered medical home. Ann Fam Med. 2010;8(suppl 1): s33-s44.

8. Reid RJ, Coleman K, Johnson EA, 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(5):835-843

9. Lee TH, Berenson RA. Chapter 2: the organization of healthcare delivery: a roadmap for accelerated improvement. In The Healthcare Delivery System: A Blueprint for Reform. Washington, DC: Center for American Progress. pdf/health_delivery_ch2.pdf. Published 2009. Accessed May 21, 2012.

10. Bojadzievski T, Gabbay RA. Patient-centered medical home and diabetes. Diabetes Care. 2011;34(4):1047-1053.

11. Berenson RA, Devers KJ, Burton, RA. Will the patient-centered medical home transform the delivery of healthcare? Urban Institute website. medical-home-transform-delivery-health-care.pdf. Published August 2011. Accessed May 15, 2012.

12. Rittenhouse DR, Casalino LP, Shortell SM, et al. Small and medium- size physician practices use few patient-centered medical home processes. Health Aff (Millwood). 2011;30(8):1575-1584.

13. Landon BE, Normand SL. Performance measurement in the small office practice: challenges and potential solutions. Ann Intern Med. 2008;148(5):353-357.

14. Nielsen M, Langner B, Zema C, Hacker T, Grundy P. Benefits of implementing the primary care patient-centered medical home: a review of cost and quality results, 2012. Patient-Centered Primary Care Collaborative website. the_primary_care_pcmh.pdf. Published September 2012. Accessed December 10, 2012.

15. Physician practice connections—patient-centered medical home 2008. National Committee on Quality Assurance website. http://www. Accessed May 12, 2011.

16. Armstrong DP, Forte GJ. Annual New York Physician Workforce Profile, 2010 Edition. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, SUNY Albany. December 2010.

17. Mostashari F, Tripathi M, Kendall M. A tale of two large community electronic health record extension projects. Health Aff (Millwood). 2009;28(2):345-356.

18. Take Care New York: A policy for a healthier New York City: Fourth Year Progress Report. New York City Department of Health and Mental Hygiene website. tcny-4yr-ar.pdf. Published March 2009. Accessed March 26, 2012.

19. National Quality Forum website. QPS/. Accessed March 19, 2013.

20. Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the US by improvements in use of clinical preventive services. Am J Prev Med. 2010;38(6):600-609.

21. Bitton A, Schwartz GR, Stewart EE, Henderson DE, Keohane CA, Bates DW, Schiff GD. Off the hamster wheel? qualitative evaluation of a payment-linked patient-centered medical home (PCMH) pilot. Milbank Q. 2012;90(3):484-515.

22. Grumbach K, Bodenheimer T, Grundy P. The outcomes of implementing patient-centered medical home interventions: a review of the evidence on quality, access and costs from recent prospective evaluation studies. Patient-Centered Primary Care Collaborative website. Published August 2009. Accessed May 15, 2012.

23. Baskerville NB, Liddy C, Hogg W. Systematic review and metaanalysis of practice facilitation within primary care settings. Ann Fam Med. 2012;10(1):63-73.

24. Lowenstein D, Wetterman T, Dougherty C. Building New York’s medical homes: learning from eight pioneers to move the model forward. Primary Care Development Corporation website. assets/pdf/building-new-york-s-medical-homes-11-18-12-final .pdf. Published November 2012. Accessed April 23, 2013.

25. Abrams M, Schor EL, Schoenbaum S. How physician practices could share personnel and resources to support medical homes. Health Affairs. 29(6):1194-1199.

26. Parsons A, McCullough C, Wang J, Shih S. Validity of electronic health record-derived quality measurement for quality reporting. J Am Med Inform Assoc. 2012;19(4);604-609.

27. Howard M, Brazil K, Akhtar-Danesh N, Agarwal G. Self-reported teamwork in family health team practices in Ontario. Can Fam Physician. 2011;57(5):e185-e191.

28. Meyer H. Group Health’s move to the medical home: for doctors, it’s often a hard journey. Health Aff (Millwood). 2010;29(5):844-851.

29. Devries A, Li CH, Sridhar G, Hummel JR, Breidbart S, Barron JJ. Impact of medical homes on quality, healthcare utilization, and costs. Am J Manag Care. 2012;18(9):534-544.

30. Proposed Policy and Payment Changes to the Medicare Physician Fee Schedule for Calendar Year 2014. CMS website. http://www.cms .gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets- Items/2013-07-08.html. Published July 8, 2013. Accessed August 6, 2013.
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up