There is growing momentum in the United States to implement changes to the health care system that will reduce costs, improve the quality of care provided, and improve the patient’s experience with care, and there is mounting evidence that transforming primary care practices into PCMHs is one way to achieve these goals.48
Findings from the TPC grants show that primary care transformation efforts have the potential to improve access to care; improve patient satisfaction with care; reduce utilization of unneeded care, particularly in emergency departments; and improve the quality of care and health outcomes, particularly for patients with chronic illnesses. However, the studies also reveal that transforming the way primary care is delivered is a complex and difficult process and will require ongoing work and investment.
This body of work also highlights a number of areas for future research. While many of the TPC grants set out to measure the costs related to primary care transformation, only a few grants were able to achieve this. To support further investigation in this area, AHRQ funded the Estimating the Costs of Supporting Primary Care Practice Transformation grant initiative, which focuses on measuring the direct and indirect expenses of primary care transformation efforts. The experiences of the TPC grantees suggest that in addition to estimating the costs of PCMH transformation, it is important to also measure and understand the costs of maintaining a PCMH and to determine whether PCMH transformation is associated with any reductions in the cost of providing primary care over time.
Only five of the 14 TPC grants reported that patients were involved in the design of primary care transformation efforts in the practices they studied, usually as part of a board or patient advisory committee. The investigators reported that this was in part because patient-centered care, self-management, and shared decisionmaking were not widely applied concepts at the time these transformation initiatives began. Additional research is needed to identify how to successfully incorporate the patient perspective into primary care redesign efforts.
Small, independent practices and safety net clinics face additional barriers to transformation because they do not have access to the resources and infrastructure available to larger, better-funded practices. The costs of implementing EHR systems, applying for PCMH recognition, and obtaining other needed resources can be out of reach for small clinics, even when financial incentives are available. Policy efforts to determine how to best support the transformation of small, independent practices and safety net clinics will be essential to ensuring these practices can provide the best care for their patients and survive in the future environment of primary care.
The successful redesign of primary care requires fundamental changes in how providers, payers, and patients think about primary care. In particular, the current physician-led model must be replaced by a patient-centered model, where care is provided by teams, and the focus is not just to improve the health of individual patients but the entire population of patients. Given the scope of this change, additional modifications to the U.S. health care payment model are needed to reward practices for improving the quality of care and the patient’s experience of care and to help sustain primary care transformation over time.
