A house is not a home: keeping patients at the center of practice redesign
The patient-centered medical home (PCMH) is the newest idea being promoted as a transformative health system model of primary care. A PCMH combines a physician-directed practice with primary care physician (PCP) services. Based on a literature review and interviews with practicing physicians, we identify the main health system problems that the medical home has been promoted to address: deficiencies in patient-centered care, the challenges of chronic care, and relatively poor primary care compensation. Medical home advocates and physicians have somewhat different, although not necessarily inconsistent, expectations of what the medical home should accomplish—from greater responsiveness to the needs of all patients to increased focus on care management for patients with chronic conditions. As the medical home concept is further developed, it will be important to not overemphasize redesign of practices at the expense of patient-centered care, which is the hallmark of excellent primary care.