Is There a Personal Doctor in the House?

Primary care medical specialty societies, including the American College of Physicians, promote the patient-centered medical home as a way to improve the U.S. health care system (1). Some of the principles of a patient-centered medical home include a personal physician, a physician-directed medical team, a whole-person orientation, care coordination, a commitment to quality and safety, and the provision of enhanced access (2). These themes are highly recognizable elements of previously published definitions of primary care (3, 4). The novelty is in the linkage of these concepts to a business proposition. Primary care advocates contend that they should be better paid to do these functions because an adequately funded, patient-centered medical home can be a cost-effective delivery model that can reduce the need for specialty and emergency department visits as well as hospitalizations (5). Payers, including Medicare, are receptive to enhanced payment for primary care as long as practices demonstrate that they adhere to the principles of a medical home and can in fact reduce overall health care costs (6). Work is under way to create measures validating a primary care practice's claim that it functions as a medical home (7) and to test whether primary care medical homes are truly cost-effective in demonstration projects (8).

In this issue, Atlas and colleagues (9) make a strong case that 1 of the basic elements of the medical home—a personal physician—increases quality. By using an innovative measure, Atlas and colleagues (9) report that patients who were more connected to a personal physician were more likely to receive recommended primary and secondary prevention services in primary care settings (9) …