Among physician organizations concerned with preserving and promoting primary care, the patient-centered medical home concept has become a top priority. The PCMH notion is bound up in the broader health care reform effort and has provoked questions and controversy. Some regard it as an appealing but largely unproven concept.¹Is it the managed care of this decade? Is it a political maneuver designed to salvage a failing primary care delivery sector? And what are the implications for PAs?

Medical Home History

The American Academy of Pediatrics introduced the medical home concept 1967 as the central source of medical records for children with special health needs. It since has evolved as a means to improve health care for patients of all ages in every setting. The medical home seeks to improve the team delivery of health care, align the many functions of health care organizations around the patient and support financing of care coordination and management.

The concept took root several years ago when the AAP, in association with the American Academy of Family Physicians, the American College of Physicians and the American Osteopathic Association, defined comprehensive guidelines for the PCMH as the central approach to improve health care.²The model has been endorsed by a broad coalition of health care stakeholders.

In the PCMH model, each patient has a personal physician or dentist who leads a team of clinicians and staff who take collective responsibility for delivering comprehensive, coordinated care that addresses all of the patient's health care needs. Other components of the concept include a team-oriented (as opposed to a physician-centered) approach, new scheduling and access arrangements, new coordination arrangements with other parts of the health care system, group visits, new ways of bringing evidence to the point of care, quality improvement activities, more point-of-care services, changes in practice management, new strategies for patient engagement and multiple new uses of information systems and technology.³

Skepticism and Hope

Aimed at evaluating the PCMH concept, 22 multi-stakeholder demonstration pilot projects are under way in 14 states. Among them is the AAFP's National Demonstration Project, which began in 2006 and studies 36 family practices that have been selected to maximize a diversity of geography, size, age and ownership arrangements. Among the preliminary concerns are that PCMH designs "seriously underestimate the magnitude and time frame for the required changes, overestimate the readiness and expectations of information technology, and are seriously undercapitalized."³Clinicians will be required to learn new skills to function in the PCMH. Current training programs do not educate future physicians, PAs and dentists in the PCMH's fundamental precepts. They must learn how to deliver team-based care, use health information technology to improve care and adopt evidence-based principles in practice. Additional needed changes include adopting the chronic care model, incorporating continuous quality-improvement methodologies, incorporating population health, using evidence-based medicine at the point of care, facilitating leadership training, supporting patient self-management, partnering with patients and thinking outside the examination room.⁴Mounting evidence shows primary care's value in assuring a health system of higher quality at lower cost, and with more equity, productivity and efficiency.^5,6The PCMH is intended to more effectively provide primary care. Still, some observers are skeptical about the PCMH and the motivations of the sponsoring physician groups, and some believe that the modern practice environment, unless radically changed, is incompatible with the PCMH concept.⁷The AAPA, in adopting a policy supporting the medical home concept,⁸ sees the PCMH as an opportunity to highlight the education, competencies and contributions of PAs as critical members of the health care team. The AAPA also is a member of the Patient-Centered Primary Care Collaborative, a coalition of more than 500 major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals and physician groups, who believe that implementing the PCMH concept will improve the health of patients and the viability of the U.S. health care system.

The outcome of the PCMH will depend heavily on the outcome of health care reform. For PAs, both have the potential to enrich practice realities and potential.

For this article's reference list, go to www.advanceweb.com/pa and click on "References" under the "Magazine" menu.

James F. Cawley is professor and vice chair of the Department of Prevention and Community Health in the School of Public Health and Health Services at The George Washington University in Washington. He indicates no relationships to disclose related to the contents of this article.