The Patient-centered Medical Home Movement — Promise and Peril for Family Medicine

John C. Rogers, MD, MPH, MEd


J Am Board Fam Med. 2008;21(5):370-374. 

In This Article


The PCMH movement may bring recognition, reward, and support to family medicine. Contrary to the negative recognition we received in the HMO/managed care movement as gatekeepers who were to control access to other providers and services, we are now receiving more positive recognition as gateways[13] whose role is to coordinate and integrate access. This time the recognition seems to be accompanied by an acknowledgment of both the health and financial benefits to patients and communities of an available primary care base. It is our intrinsic worth—just being present—that benefits the public, not our control of access to other services. The reward and support may be increased compensation to individual physicians and reimbursement that will fund development of infrastructure provided that the payment system fulfills the stated principles:

  • It should pay for services associated with coordination of care.

  • It should allow for separate fee-for-service payments.

  • It should allow for additional payments for achieving measurable quality improvements.

  • It should support provision of enhanced communication access.

  • It should support use of health information technology for quality improvement.

Recognition, reward, and support are sometimes viewed in terms of power and prestige; an alternative view is to think of them in terms of equality and equity. Either way, more appropriate levels may help with retention in practice of current family physicians and enhance the recruitment of students to family medicine that would be necessary to meet the goal of a personal medical home for every person in the United States.


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