Lessons Patient-Centered Medical Homes Can Learn From Health Maintenance Organizations’ Mistakes

Ann M. Mirabito, Baylor University
Leonard L. Berry, Texas A&M University

Patient-centered medical homes (PCMHs) have been endorsed by primary and specialty care medical associations, payers and patient groups as an innovative structure for transforming healthcare delivery. The cornerstone principle of the PCMH is the primary care physician’s coordination of a patient’s use of healthcare services, including visits to specialists, to improve effectiveness and efficiency. This principle aligns with the vision behind the creation of health maintenance organizations (HMOs), managed care organizations that were once embraced by physicians, patients and policy analysts but have since lost much of their luster. Many patients and physicians rejected HMOs as too restrictive, objecting particularly to the concept of gatekeeping. This paper reviews the HMO experience and identifies lessons applicable to PCMHs that build on HMO strengths and avoid HMO mistakes.

 

* This paper is published in Annals of Internal Medicine, February 2, 2010, pp. 182-185.