The Inner Workings of the Patient Centered Medical Home Model

The patient-centered medical home (PCMH) is a model for restructuring primary care with a focus on improved access to care and clinical excellence. However, to date, the evidence on its effect on healthcare utilization and expenditures has been quite mixed. One possible reason for this may lie in the flexibility with which a practice can meet the thresholds for PCMH recognition, adopting practice reforms in vastly different domains. Hence, practices with the same recognition level may in fact demonstrate divergent capabilities, and subsequently have different leverage over the achievement of the PCMH goals. We study this idea by using previously unavailable data that spans all PCMH recognition domains. The richness of our data allows us to group practices into clusters based on their choice of attributes during the recognition process, and then examine the performance of individual clusters in reducing healthcare utilization and expenditures. We find that treating the PCMH model as an undifferentiated intervention obscures meaningful variation in implementation across practices. In particular, clusters emphasizing practice improvements like use of decision support, enhanced access to care and population management tools have demonstrated some success in impacting utilization and expenditures patterns after PCMH recognition.