The policy context of patient centered medical homes: perspectives of primary care providers.
BACKGROUND
Interest in the patient centered medical home (PCMH) model has increased significantly in recent years. Despite this attention, information is limited regarding the influence of policy context on implementation of the PCMH model. Using comparative, qualitative data, we identify several key policy impediments to PCMH implementation, and propose practical guidelines for addressing these issues.


METHODS
Qualitative, semi-structured in-person interviews with representatives of physician organizations and primary care practices pursuing PCMH.


METHODS
Practitioners and staff at 16 physician practices in Michigan, as well as key leaders of physician organizations.


RESULTS
We identified five primary policy issues cited by physicians and physician organization leaders as most impactful on their efforts to adopt PCMH: misalignment of current reimbursement schemes, administrative burden, conflicting criteria for PCMH designation, workforce policy issues, and uncertainty of health care reform. These policies were largely seen as barriers to their ability to implement PCMH.


CONCLUSIONS
Providers' motivation to embrace PCMH, and their level of confidence regarding the results of such change, are greatly influenced by their perception of the external environment and the control they believe they have over this environment. Having policies in place that shape the path to PCMH in a manner that makes it as easy as possible for providers to accomplish the desired changes could well make the difference in whether successful transformation is achieved.
Department of Health Management and Policy, The University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. jalexand@umich.edu
Jeffrey A
JA
Alexander
Genna R
GR
Cohen
Christopher G
CG
Wise
Lee A
LA
Green
D001291:Attitude of Health Personnel; D018166:Health Care Reform / Q000458:organization & administration*; D006284:Health Plan Implementation / Q000458:organization & administration; D006302:Health Services Research; D006801:Humans; D008824:Michigan; D016134:Organizational Policy; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D000078329:Workforce; D016526:Workload