Transforming smaller physician practices into patient-centered medical homes presents great opportunities for higher-quality care at lower costs for patients who have complex healthcare needs, but payment reforms are needed, according to a report in the Annals of Family Medicine.

The report, written by researchers at Mathematica Policy Research in Washington, asserts that payment changes must be made to reimburse these practices for time spent coordinating care and for integrating care coordinators into primary-care teams.

Dr. Eugene Rich and colleagues studied organizations operating as medical homes in Massachusetts, Minnesota, North Carolina, Ohio and Wisconsin, and their findings appear in the American Academy of Family Physicians' journal as well as in a longer white paper published by HHS' Agency for Healthcare Research and Quality. The study was funded by AHRQ.

In the white paper, "Coordinating Care for Adults With Complex Care Needs in the Patient-Centered Medical Home: Challenges and Solutions," the researchers noted that larger medical groups may have more personnel to provide care coordination or have a large enough patient base to allow clinicians to specialize in areas such as geriatrics or HIV medicine. Small practices, however, usually don't have the staff flexibility to dedicate individuals solely to concentrate on care coordination or have enough patients with similar complex needs to allow for clinician specialization.

One solution, the authors suggest, could be contracting case coordinators or using care managers as a "shared resource" among a network of practices.

"Managing the care of patients with complex needs requires substantially more time and care-coordination resources than more typical patients with chronic conditions," according to the white paper. "This is a tall order for most small practices, even those that meet the basic requirements for a medical home … Accordingly, most of the programs described in this paper provide resources that are shared across several small practices. These shared resources include specially trained advance practice nurses and social workers available to help the small (primary-care practices) assess and plan care of their complex patients."

The authors also note that more research is needed to determine the optimal training for these "relevant professionals" as well the proper deployment and support they would need to achieve integrated care in a community.