Perceived Impact of PCMH Status on Patients
Many physicians provided anecdotal evidence or hypothesized about how organizing like a PCMH was related to better patient care, but few had seen information they felt could help them assess the impact on utilization or clinical outcomes (Table 4). Most physicians, particularly family physicians, felt they were even less able to assess impacts on the subpopulation of CSHCN in their practice because the group was small and diverse. For those who did discuss impacts on CSHCN, they emphasized the importance of continuity of care, using registries to track patients for proactive preventive and chronic care management, and care coordination involving formal care coordinators and exchange of information with other care sites, such as EDs and specialists' offices.
Perceived Impact of PCMH-Recognition Process on Practices
Many physicians viewed PCMH-recognition as a stepping stone for improved financial arrangements with payers, including per-member-per-month care management payments on top of fee-for-service and pay-for-performance reimbursements (Table 4). Additionally, some physicians described how their practices leveraged their PCMH infrastructure for participation in additional system transformation initiatives that could be beneficial to their patients' care and their practices' reputation and finances. These included state and federally funded PCMH initiatives, health information exchanges, EHR meaningful use programs, and accountable care organizations (ACOs). In one extreme example, a family physician described how his practice expected "an extra $2 million over the next four years" through participation in a state Medicaid ACO, a state immunization database, a national practice-based research consortium, a federal quality measures reporting initiative, and a federal primary care transformation program.