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I t is widely known that the US health care system has high cost and poor outcomes compared to other developed countries,1 largely due to lack of a strong primary care system.2 The Joint Principles of the PatientCentered Medical Home (PCMH) was developed in 2007 as a strategy to address this problem.3 The PCMH can be summarized as combining the basic principles of primary care with new ways of organizing and delivering care and increased reimbursement to support this new model of primary care.2 One of the key elements of the PCMH is having a physician-led team that coordinates each patient’s care with the rest of the health care system. But given that primary care offices in the United States are increasingly becoming part of hospitals and other integrated health care systems,4 is the PCMH becoming obsolete? I would argue that not only is the PCMH still an essential component of achieving the triple aim both inside and outside of integrated health systems, but that it is also an important way to guard against the detrimental effects of too much consolidation of primary care practices into hospital systems. Much of the evidence of benefit for the PCMH has come from large integrated health care systems. At Group Health Cooperative Puget Sound, the PCMH model improved quality of care as well as patient and provider satisfaction, and reduced emergency department (ED) visits and hospital admissions.5 Similar improvements have been seen in the Veterans Administration system,6 Geisinger Health System in Pennsylvania,7 and other large integrated systems.8 Given the positive impact in large integrated health care systems, it would seem that the PCMH model of care is still relevant in that context. But since large health care systems rely on their primary care practices for referrals to their more lucrative specialty and hospital services, one could surmise that the PCMH might not achieve its greatest benefit in these systems. In fact, the greatest potential benefit for the PCMH is in small independent practices. Studies of the PCMH in independent practice have been more mixed. One study of these practices in southeastern Pennsylvania found improvements in diabetes,9 but a more recent study exploring a wider set of outcomes in the same regional PCMH program found few positive results.10 And a study of five PCMH practices in Rhode Island found significant reductions for avoidable ED visits, but not for other hospital utilization or for diabetes and preventive care.11 These results might seem surprising, since one of the hallmarks of the PCMH is to coordinate primary care with the rest of the health Will Consolidation of Primary Care Into Hospital Systems Spell Doom for the PatientCentered Medical Home and the US Health Care System?

Will Consolidation of Primary Care Into Hospital Systems Spell Doom for the Patient-Centered Medical Home and the US Health Care System?