Patient-Centered Medical Home

National health care reform legislation calls for implementation of the patient-centered medical home model of care. With its emphasis on better care coordination and improved access to care, this model has the potential to enhance quality of care while reducing costs.

Commonwealth Medicine has taken a leadership role in the development of the patient-centered medical home model — and we are actively putting it into practice.

Medical homes in Massachusetts

Our consultants are working in partnership with the Massachusetts Executive Office of Health and Human Services and Bailit Health Purchasing to reform primary care in the state by launching a service delivery model that emphasizes care coordination and improved access to care. The patient-centered medical home is distinguished by its focus on

  • Physician-directed medical practice
  • Whole-person orientation
  • Coordinated and integrated care
  • Quality and safety
  • Enhanced accessibility
  • Payment that recognizes the value of the model

The Massachusetts Patient-Centered Medical Home Initiative, involves implementing and evaluating the model in 45 primary care practices across Massachusetts. This three-year, multi-payer demonstration project began in March 2011. It is based on four key concepts:

  • Practice redesign — transforming health care delivery to incorporate the principles of the medical home model
  • Consumer engagement — ensuring that the focus is on patients and their families
  • Incentive alignment — instituting programs such as pay-for-performance, enhanced care management fees, and shared savings
  • Evaluation — examining the implementation and performance of the pilot program to improve and streamline the model

Commonwealth Medicine’s role

Commonwealth Medicine is responsible for implementing the following aspects of the initiative:

  • Engaging consumers and communities in this model of care
  • Providing faculty for learning collaboratives and online courses/webinars
  • Developing a service to provide practice-based medical home facilitators for participating medical practices
  • Providing technology support: website, registry, data aggregation, and reporting
  • Evaluating and reporting the demonstration project

After completing an evaluation of the model, Commonwealth Medicine will also be involved in rolling out the model across Massachusetts. It is envisioned that all primary care practices in the commonwealth will be patient-centered medical homes by 2015.