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Comment & Response |

Evaluating a Multipayer Medical Home Intervention

George Valko, MD1; Richard Wender, MD2
[+] Author Affiliations
1Department of Family and Community Medicine, Jefferson Medical College, Philadelphia, Pennsylvania
2American Cancer Society, Atlanta, Georgia
JAMA. 2014;312(4):434-435. doi:10.1001/jama.2014.7137.
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To the Editor As physicians involved in the Pennsylvania Chronic Care Initiative (PACCI), a medical home pilot, we are concerned that the evaluation of the first phase had many inadequacies that steered Dr Friedberg and colleagues1 to the wrong conclusions. These conclusions have the potential to impede further payment reform and block continued redesign of primary care practices.

This study examined data from the first 3 years of the initiative, a time frame that is too short to detect changes resulting from the intervention. Phase 1 of this program was devoted to building the infrastructure and culture to earn National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) recognition and become a true medical home; reduction in costs of care was not a goal. In phase 2, pilot practices added case management and other quality interventions to the PCMH model. Our practice is just starting to observe reductions in emergency department visits, hospitalizations (including reductions in 30-day readmissions), and costs of care attributable to PCMH changes and the PACCI.


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July 23, 2014
Mark W. Friedberg, MD, MPP; Eric C. Schneider, MD, MSc; Rachel M. Werner, MD, PhD
1RAND Corporation, Boston, Massachusetts
2Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
JAMA. 2014;312(4):436. doi:10.1001/jama.2014.7146.
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