Jonathan Sugarman, Edward H. Wagner, Melinda K. Abrams, Kathryn E. Phillips, and Katie Coleman
J. R. Sugarman, K. E. Phillips, E. H. Wagner et al., “The Safety Net Medical Home Initiative: Transforming Care for Vulnerable Populations,” Medical Care, Nov. 2014 52(11 Suppl. 4):S1–S10.
Studies have shown that medical homes can improve the quality and efficiency of health care and enhance patients’ overall experiences. Most medical home demonstration projects have focused on health care providers serving commercially insured or Medicare patients. But the Safety Net Medical Home Initiative, a five-year demonstration launched in 2008 with Commonwealth Fund support, targeted health clinics that serve low-income communities.
The primary care practices that participated in the initiative included a mix of rural and urban federally qualified health care centers, homeless clinics, residency training programs, private practices, and other settings, which all together cared for over half a million patients. In addition to technical assistance, these practices were eligible for stipends for field trips, data infrastructure, and training, among other activities.
By March 2013, evaluations showed that all sites had achieved some level of implementation, and nearly half (48%) had put in place the 33 identified “key changes” to a substantial degree. Most sites (83%) achieved medical home recognition from an accrediting body, like the National Committee for Quality Assurance. The vast majority of practices (92%) agreed or strongly agreed that the program’s training materials helped them learn about the changes necessary for becoming a medical home.
Practices cited five challenges to medical home implementation: the impact of staff turnover, especially leaders; engaging staff support; financial constraints; competing priorities; and limited capacity to collect and report data.
The kinds of changes involved in medical home transformation do not take months to realize—they take years, possibly three to four. The researchers also found that practices undergoing transformation benefit greatly from direct, face-to-face interaction with peers and site visits.