Implementing a Patient-Centered Medical Home: Interprofessional Conflict as a Barrier in Population Health

• In Event: 030 - Regular Session. Health Care and Care Delivery

Abstract

Proposals to improve population health have often focused on improving healthcare delivery, especially the delivery of primary care. This paper examines recent proposals to broaden the scope and impact of primary care through the creation of a Patient-Centered Medical Home. The PCMH has been embraced by various institutional actors, including professional associations that seek to protect the prestige and jurisdictional authority of healthcare professionals, and governmental actors that are responsible for ensuring quality, controlling costs, and promoting the overall health of the population. In this paper, we draw on institutional theory to show how the PCMH has matured over time, and how the specific routines and practices that comprise contemporary primary care in this regime have evolved in response to shifts in the underlying institutional logics as new stakeholders and champions have come aboard. We illustrate how federal policies that guide the administration of Patient Centered Medical Home programs align with the technical and normative goals of clinicians and fall short of serving public health surveillance and prevention needs. Ensuring population health will require the integration of healthcare services along three dimensions: longitudinal (i.e., provide high quality care across the patient’s life span); horizontal (i.e., integrate primary care with specialty medical care and related health services); and vertically (i.e., integrate healthcare services with community oriented public good such as public education, poverty reduction, and social justice). We show how PCMH routines have embraced longitudinal and horizontal integration, but have virtually ignored vertical integration.

Authors

• Laura Senier, Northeastern University

• Jessica von Reyn, University of Wisconsin-Madison