Patient-Centered Medical Home Transformation with Payment Reform: Patient Experience Outcomes

Patients at a large primary care clinic that adopted the patient-centered medical home model, along with improvements in disease management and changes to staffing and physician payment, reported improved satisfaction with their care, including better communication with providers. The findings run contrary to previous research that concluded the care model, which requires practices to undergo intensive and potentially disruptive transformation, can negatively affect patients’ experiences in the short term.

Some research indicates that, although the patient-centered medical home (PCMH) has the potential to improve patient care quality and reduce costs, implementing the reforms at the center of the model—including reorganizing staff into care teams and adopting electronic medical records—can lead to declines in patient satisfaction in the short term. Commonwealth Fund–supported researchers compared patients’ experiences in a primary care clinic that implemented the PCMH model, along with lean process changes (which seek to maximize value and reduce waste) and a new approach to physician reimbursement, with patients’ experiences in a similar clinic that did not make such changes. The lean changes focused on improving chronic disease management and reassigning tasks traditionally performed by physicians to medical assistants or nurses. The new payment approach replaced physicians’ fee-for-service–based compensation with a salary and bonus arrangement.

Key Findings:

• At the intervention site, overall satisfaction was higher following adoption of the new care model: 68 percent of patients rated their care as "very good," compared with 62 percent prior to the intervention.
• At the control site, 63 percent of patients were satisfied during the pre-intervention period compared with 64 percent after.
• The researchers found no statistically significant differences in patients’ overall satisfaction between the intervention and control sites, though there were some trends toward improvement.
• At the intervention practice, there were patterns of consistent or improved patient satisfaction on measures assessing physician communication. Following the intervention, patients rated their providers the same or more highly on the amount of time they spent with them, their expressions of concern, follow-up instructions, and explanations provided. In contrast, control practice patient ratings fell during the study period.