Getting from here to there: Application of implementation science to a patient-centered medical home program

To evaluate the development, implementation and efficacy of the Patient Centered Medical Home Model; identify factors which influence its success; and identify potential modifications to statutes or administrative rules that further health system transformation goals. Methods include semi-structured interviews and document analysis based on an implementation science framework. Findings suggest that internal opinion leaders and external change agents may mitigate resistance and facilitate support for the Program among administrative entities and clinical sites. Findings also indicate that financial incentives were a challenge to implementation; critical incentive for participation; and important factor influencing the pace of progress. Although consumer engagement is a key element of the program, evidence for, and the efficacy of such involvement is mixed. The enabling legislation itself appears to be a crucial element for defining program intent, incentives, processes and expectations; and is complemented by structured administrative rules and agency policies. Finally, eligibility criteria, certification metrics, and payment processes and systems influence participation at the clinic level. Our analysis highlights the relative influence of statutes, administrative rules, department policies, accountability metrics, and payment systems as unique elements that both define and influence the implementation of PCMH programs. Clearly articulating statutory intent, program structure, and accountability processes can facilitate implementation, particularly under conditions in which timelines are short and service providers must coordinate multiple system reform initiatives. While financial support is critical to efforts to incentivize coordination among physical, behavioral and oral healthcare providers, clarity of policy intent, authority and technical assistance are necessary to ensure successful implementation.