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In 2008, the Commonwealth of Pennsylvania began a statewide chronic care initiative to adopt the patient-centered medical home (PCMH). The initial target disease was diabetes. Our research team, comprising experts in medicine, communication, social work, and practice facilitation, studied 25 practices in the first region of the state to begin the program. All the practices participated in a regional learning collaborative, were recognized as PCMHs by the National Committee on Quality Assurance (NCQA),1 and received supplemental payments from six area insurers to support their transformation. Overall, practices achieved better clinical quality for diabetes care with an increase in the percentage of patients meeting evidence-based goals.2 For example, the percentage of patients with hemoglobin A1C levels above 9 declined from 30.7 percent at the start of the initiative to 28.2 percent one year later. Cholesterol-fighting efforts had the biggest impact with the percentage of patients with LDL levels under 130 rising 8.5 percent during the year.
We conducted 140 in-depth qualitative interviews during 2010 and 2011 with providers, administrators, and practice staff to understand their PCMH transformation process. The interviews revealed how adapting the roles of medical assistants (MAs) enhanced the practices' ability to achieve PCMH standards and quality improvement. The aggregate focus on this profession more than others as a variable to increase practice capacity was notable and demanded our attention. With a scope of work that traverses general, administrative, and clinical responsibilities,3 MAs can be used to augment the capacity of physicians and nurses, can move into newly developing practice roles such as health coaches, or can assume more instrumental roles in population management.
Seven strategies most frequently mentioned during the interviews as being successful and central to PCMH implementation are described in this article and presented in the table below. All were widely used by the practices and were shared at learning collaborative sessions. (It should be noted that we were unable to determine whether the use of MAs in the PCMH model affected the cost of providing care because we didn't have access to claims data.)
Strategy #1: Organizing MAs into provider teams
Family physicians would need to spend 21.7 hours per day to meet all the acute, chronic, and preventive care needs of their...