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Creating the patient centered medical home

BMJ 2014; 349 doi: (Published 03 October 2014) Cite this as: BMJ 2014;349:g4916
  1. Bob Roehr, freelance journalist, Washington, D.C. USA
  1. Correspondence to: bobroehr{at}

“Our healthcare system is broken,” says Mark Frazer, a primary care physician in a small private practice in Middletown, a city of about 50 000 in southwestern Ohio. He has embraced the patient centered medical home (PCMH) as a model that is “improving healthcare delivery, patient health, and potentially has the ability to lower costs.”

The transition hasn’t been easy for Frazer, who is now in his second year participating in a demonstration project. He shared that experience and his thoughts on the medical home concept with Capitol Hill staffers at a briefing on 30 May, which was organized by the nonpartisan Alliance for Health Reform.1

The PCMH, coupled with a move away from fee for service reimbursement, are cornerstones of healthcare reform in the US.

Kaiser Permanente, the Geisinger Health System, and other integrated healthcare systems have embodied this approach for decades. They score well in terms of patient health outcomes and satisfaction, while their costs are at or below those of other providers in the same market.

But much of healthcare remains fragmented. Those stakeholders have been scurrying to integrate delivery of care in anticipation of changes in reimbursement by government and private health insurers.

The chief method has been through acquisition. Consolidation among hospitals has been under way for some time and in the past few years that wave has expanded to include purchase of medical specialty and primary care practices. Voluntary coordination of care between independent providers and hospitals has been attempted less frequently.

The principles of a PCMH are clear: “delivering team-based care in a coordinated way that is connected with the community,” is how Amy Gibson, who leads the Patient-Centered Primary Care Collaborative (, describes it. That can take a variety of forms, as can the journey from the current fragmentation to a more …

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