"I think highly of the people who conducted this study," he says. "They didn't do that study thinking it wasn't going to work."
For that matter, no one undertakes the substantial investment in the tools and human capital necessary to achieve PCMH designation thinking it's not going to work either. But the results speak for themselves. Or do they?
Not the Final Word
Langston cautions that while the study measured the before and after performance of 32 early-adopting practices over a three-year period between Jun 1, 2008 and May 31, 2011, it is not the final word on the effectiveness of the medical home construct, especially as far as patient preferences are concerned.
While the JAMA study's findings show little progress toward the goals of the PCMH, its results don't necessarily reveal the true picture of the benefits the medical home can deliver in both cost and quality spectrums, says Langston. In other words, the jury is still out, in his mind.
"In the methodology, only half the participating practices actually reached Level III [the highest PCMH designation]—only 16–so are we really evaluating the patient-centered medical home?" he asks. "The medical home lays out the walls and ceiling but doesn't decorate the room."
What distinguishes the failures from the successes in primary care, he says, is going to another level of specificity of the elements in the PCMH that are intended to help patients better access the care they need and keep themselves healthier.