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JAMA Forum

A Pulse Check on Primary Care Transformation

Transforming primary care was encoded into the Affordable Care Act as a central part of reforming how health care is delivered. Major investments supported enhanced reimbursement for primary care, community health center expansion, and multipayer partnerships for practice transformation. Federal funding has been locally augmented by state governments, private payers, and nonprofit and philanthropic organizations—often to support adoption of the patient-centered medical home (PCMH) model of care.

By 2015, a number of these initiatives have matured enough to produce evaluable results. An Agency for Healthcare Research and Quality synthesis report of 14 grants to study primary care transformation revealed few overarching “pearls.” Instead, the success of transformation depended on context. External recognition as a PCMH-certified practice alone was seldom sufficient as a marker of meaningful transformation from the patient’s perspective.

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