Abstract for:A Causal Theory of Primary Care Transformation: The Mechanisms Involved in Implementing the Patient Centered Medical Home
It has been almost 12 years since the earliest Patient-Centered Medical Home (PCMH) pilots were launched. Evaluations of these pilots documented varying degrees of transformation and impacts. With the proliferation of multipayer, state, and federal payment reform initiatives, many practices are now embarking on transformations like those undertaken by early adopters a decade ago. We developed a simulation model of a primary care team transitioning from traditional to PCMH care, primarily using mental data from 10 primary care clinics and is parameterized based on nationally-representative studies. This model was also verified via numerous quantitative and qualitative validation techniques. The model identifies causal structures that endogenously produce the behaviors observed by stakeholders and permits stakeholder-specific recommendations. These findings are useful to those now embarking upon transformation as well as those in process as recommendations are based upon an endogenous understanding of the challenge of transformation. Management’s policy decision regarding the initial amount of task-shifting required is the most impactful leverage point, followed by care team members’ preferences.