Medical home findings out-of-date

There's an old saying that any publicity is good publicity—but outdated information can mislead. Well-informed voices must speak up in that case.

That's our situation at the National Committee for Quality Assurance following publication of a JAMA study on patient-centered medical homes. Although commendable in its focus, the study contains misconceptions.

As longtime advocates of the model, NCQA believes in the power of medical homes to transform primary-care practices. Our PCMH recognition program is the nation's largest—roughly 10% of all primary-care clinicians in the U.S. participate at nearly 7,000 practice sites. Participating practices must meet rigorous standards for addressing patient needs, working with patients in long-term partnerships, rather than through hurried, sporadic visits.

We recognize that primary-care transformation is a process and that NCQA standards must keep up with the times. Since its launch in 2008, our medical-home program has been updated twice—in 2011 and again this year—and it is constantly evolving based on what we learn from practices, collaboratives and sponsors. Program incentives have evolved in many markets from simple adoption of the standards to achieving triple-aim goals—improved quality, cost and patient experience.

Unfortunately, the recent JAMA paper, suggesting low impact from PCMH models, assessed practices with 2008 standards, rather than the more recent ones. Consequently, results are outdated and unintentionally misrepresentative. It's like looking at a 2008 BlackBerry to assess the iPhone 5. The world has changed, and so have standards for medical homes.

The JAMA paper also contradicts studies showing that medical homes result in clear improvements in cost, quality, access and patient experience. One analysis released this January by the Patient-Centered Primary Care Collaborative found that 61% of peer-reviewed studies identified reductions in per-member per-month costs and in the use of unnecessary or avoidable services.

Working toward measuring outcomes in medical homes is an NCQA priority. Our goal is a balance of structural and performance measures. At this point, however, structural measures are the best option until we have broad agreement and good data sources on the best outcome measures to use in evaluating medical homes. We will work to forge consensus on appropriate patient-reporting tools and on the best sources for quality and utilization data.