Physician Perspectives on Medical Home Recognition for Practice Transformation for Children

Objective

To examine child-serving physicians’ perspectives on motivations for and supports to practices in seeking patient-centered medical home (PCMH) recognition, changes in practice infrastructure and care processes before and after recognition, and perceived benefits and challenges of functioning as a PCMH for the children they serve, especially children with special health care needs (CSHCN).

Methods

Semi-structured interviews with 20 pediatricians and family physicians at practices that achieved National Committee for Quality Assurance (NCQA) Level 3 PCMH recognition before 2011. We coded notes and identified themes using an iterative process and pattern recognition analysis.

Results

Physicians reported being motivated to seek PCMH recognition by a combination of altruistic and practical goals. Most said recognition acknowledged existing practice characteristics, but encouraged ongoing, and in some cases substantial, transformation. While many physicians said recognition helped practices improve financial arrangements with payers and participate in quality initiatives, most physicians could not assess the specific benefits of recognition on patients’ use of services or health outcomes. Challenges for practices in providing care for children included managing additional physician responsibilities, communicating with other providers and health systems, and building sustainable care coordination procedures.

Conclusions

PCMH recognition can be valuable to practices as public acknowledgement to payers and patients that certain processes are in place, and can also catalyze new and continued transformation. Programs and policies seeking to transform primary care for children should leverage physicians’ motivations and find mechanisms to build practices’ capacity for care management systems and linkages with the medical neighborhood.