and Research Agenda

Initiatives to establish and sustain patient-centered medical homes (PCMHs) around the country are associated with a broad set of objectives that include strengthening the primary care workforce, improving the quality of care, and making care more respon-sive to patient needs and preferences. The desire to improve the efficiency of care and reduce total costs,1 however, are the most compelling reasons why payers and policy makers have thrown their support behind these efforts. To date, the ability of the PCMH to achieve the anticipated improved efficiency and cost reductions remains unproven. As pilots multiply it will be increasingly important to articulate and stan-dardize an explicit set of performance benchmarks that will enable payers and providers to evaluate and compare the cost effectiveness of the varied PCMH models in progress. Without the establishment and assessment of such benchmarks for impacts on efficiency and costs, the PCMH experiment, like so many previous health policy initiatives, risks being undone by a failure to live up to unrealistic expectations. This article, submitted to Medical Care Research and Review on September 30, 2009, was accepted for publication on March 3, 2010