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Unlocking the Black Box: Supporting Practices to Become Patient-Centered Medical Homes

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The five-year Safety Net Medical Home Initiative was launched with Commonwealth Fund support in 2008 to help 65 safety-net clinics in five states become patient-centered medical homes. The project team developed a technical assistance framework to assist practices in adopting the medical home model.

What the Study Found

The components of the technical assistance framework included: 
  • individual site-level coaching by medical home facilitators, which most sites received monthly (61%) or at least quarterly (22%);
  • the creation of a learning community to help health centers interact with each other to share best practices and brainstorm;
  • data monitoring and feedback on selected measures of clinical quality, transformation, patient experience, provider and staff satisfaction, and utilization;
  • resources and materials, including guides, tools, and webinars; and
  • small grants to fund special projects like staff training videos or patient education materials.


In a survey, practices indicated that peer-learning opportunities, including in-person meetings and field trips, were particularly helpful. However, gathering, reporting, and using clinical data for quality improvement remain challenges for many practices.

Publication Details

Publication Date: October 27, 2014
Author: Edward H. Wagner, Jonathan Sugarman, Katie Coleman, Kathryn E. Phillips, Nicole van Borkulo, Donna M. Daniel, and Karin E. Johnson
Contact: Jonathan Sugarman, President and CEO, Qualis Health
Summary Writer: Deborah Lorber
Citation: K. Coleman, K. E. Phillips, N. Van Borkulo et al., "Unlocking the Black Box: Supporting Practices to Become Patient-Centered Medical Homes," Medical Care, Nov. 2014 52(11 Suppl. 4):S11–S17.


Director (Emeritus), MacColl Center for Health Care Innovation
President and CEO, Qualis Health