Safety-net health centers across the country are in the process of adopting the patient-centered medical home (PCMH) model to enhance their capacity to provide affordable, accessible, and quality health care for underserved, minority, and low-income patients. While PCMH transformation evaluations have been conducted in family practice and large health system settings, less is known about how the process works in resource-constrained safety-net health centers. This Commonwealth Fund–supported article reports on the early adoption experiences of safety-net health center administrators, providers, and staff.
The researchers interviewed 98 respondents at 20 safety-net health centers in Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania in their first year of operating patient-centered medical homes. Many of those interviewed expected the model to yield such benefits as greater work satisfaction, higher staff retention, and improvements in patient access to care and health outcomes. Obstacles encountered included staff skepticism, resistance to change and, most important, the shortage of steady funding from state Medicaid programs. The interviews also yielded early lessons: transformation takes time, staff must be involved early in the change process, and frequent data-driven feedback is an important motivator.
Although the PCMH is a promising model for providing continuous, high-quality care to underserved Medicaid populations, reliable and adequate funding is critical for success. A restructured reimbursement system that rewards this type of continuous, comprehensive care is key to wider adoption of the model.