title: Medical Home Implementation in Small Primary Care Practices: Provider Perspectives.
abstract: CareFirst BlueCross BlueShield of Maryland implemented a voluntary patient-centered medical home (PCMH) program in 2011 that did not require formal certification to participate. This study assessed attitudes and awareness of PCMH programs among participating providers in Maryland and Northern Virginia.
  
  
  
  This qualitative study used information from 13 focus groups. In addition, 39 telephone interviews were conducted. An experienced facilitator moderated the focus groups. Written transcripts were analyzed using NVivo software.
  
  
  
  Several cross-cutting themes emerged. First, the payment bump of 12% was a motivating factor to participate but did not have long-term effects on participation. Second, nurse care coordinators were perceived as the key element of the PCMH program. Third, providers had limited awareness of an external data portal. Finally, small practices were generally receptive to the externally supported program elements.
  
  
  
  Implementation of PCMH program elements can be facilitated in small primary care practices even if third-party certification is not a requirement. Participating providers viewed having an external nurse care coordinator as the key element of the PCMH program. Small practices were receptive to external supports, but a lack of trust was viewed as a barrier to implementing a payer-based medical home program.
authors.affiliation: From the Department of Health Administration and Policy, Center for Health Policy Research and Ethics, and School of Nursing, George Mason University, Fairfax, VA (GG, TP, MR, LMN); the Center for Improving Value in Health Care, Denver, CO (JW); and Alan Newman Research, Richmond, VA (DH).
authors.forename: Gilbert
authors.initials: G
authors.lastname: Gimm
authors.affiliation: From the Department of Health Administration and Policy, Center for Health Policy Research and Ethics, and School of Nursing, George Mason University, Fairfax, VA (GG, TP, MR, LMN); the Center for Improving Value in Health Care, Denver, CO (JW); and Alan Newman Research, Richmond, VA (DH).
authors.forename: Jay
authors.initials: J
authors.lastname: Want
authors.affiliation: From the Department of Health Administration and Policy, Center for Health Policy Research and Ethics, and School of Nursing, George Mason University, Fairfax, VA (GG, TP, MR, LMN); the Center for Improving Value in Health Care, Denver, CO (JW); and Alan Newman Research, Richmond, VA (DH).
authors.forename: Dan
authors.initials: D
authors.lastname: Hough
authors.affiliation: From the Department of Health Administration and Policy, Center for Health Policy Research and Ethics, and School of Nursing, George Mason University, Fairfax, VA (GG, TP, MR, LMN); the Center for Improving Value in Health Care, Denver, CO (JW); and Alan Newman Research, Richmond, VA (DH).
authors.forename: Treniese
authors.initials: T
authors.lastname: Polk
authors.affiliation: From the Department of Health Administration and Policy, Center for Health Policy Research and Ethics, and School of Nursing, George Mason University, Fairfax, VA (GG, TP, MR, LMN); the Center for Improving Value in Health Care, Denver, CO (JW); and Alan Newman Research, Richmond, VA (DH).
authors.forename: Margaret
authors.initials: M
authors.lastname: Rodan
authors.affiliation: From the Department of Health Administration and Policy, Center for Health Policy Research and Ethics, and School of Nursing, George Mason University, Fairfax, VA (GG, TP, MR, LMN); the Center for Improving Value in Health Care, Denver, CO (JW); and Alan Newman Research, Richmond, VA (DH).
authors.forename: Len M
authors.initials: LM
authors.lastname: Nichols
mesh_terms: D001291:Attitude of Health Personnel; D054598:Blue Cross Blue Shield Insurance Plans / Q000331:legislation & jurisprudence*; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008396:Maryland; D009726:Nurses; D018802:Patient-Centered Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods*; D058007:Physicians, Primary Care; D057285:Precision Medicine; D011320:Primary Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods*; D036301:Qualitative Research; D018855:Single-Payer System; D013689:Telephone; D014768:Virginia; D000078329:Workforce
keywords: Blue Cross Blue Shield Insurance Plans; Focus Groups; Nurse Practitioners; Patient-centered Care; Physicians; Primary Care; Qualitative Research; Quality Improvement