Provider Experiences with a Payer-Based PCMH Program

  • Gilbert GimmEmail author
  • Debora G. Goldberg
  • Nouran Ghanem
  • Sahar Haghighat
  • Jay Want
  • Dan Hough
  • Len M. Nichols
Original Research



The patient-centered medical home (PCMH) is an enhanced primary care model that aims to improve quality of care. Over the past several years, the PCMH model has been adopted by Medicare and private payers, which offer financial resources and technical assistance to participating practices. However, few studies have examined provider experiences and perspectives on the adoption of payer-based PCMH models in different practice settings.


The goal of this qualitative study was to analyze how providers experienced specific elements of a payer-based PCMH model and identify cross-cutting themes that can be applied to other payer-based PCMH initiatives.


Observational qualitative study.


A total of 65 individuals (which includes 57 primary care physicians) participated in focus group sessions. Telephone interviews were conducted with an additional 14 physicians and 2 practice administrators.


Interviews and focus groups were recorded after obtaining the informed consent of participants. Written transcripts from the recordings were then imported into NVivo 11 for subsequent coding and qualitative analysis of themes.

Key Results

We found that nurse care coordinators (NCCs) were the single most valuable and visible program element. Individual care plans served as effective tools of communication between the NCC and physician on patient care management goals and issues. The online data portal was viewed as the least valuable element. With regard to cross-cutting themes, some providers expressed a strained relationship with CareFirst due to communication challenges, a lack of trust, and differing priorities in selecting patients for care plans.


Nurse care coordinators and the targeted use of individualized care plans are essential components in a payer-based PCMH program. Improving communication and trust in data reports are critical for effective implementation. Future research should examine provider experiences in other payer-based PCMH programs to see how interactions with payers affect program implementation.


provider experiences qualitative patient-centered medical home 



We would like to thank Alan newman Research for their contributions in the production and gathering of written transcripts for this study.

Financial Disclosure

This program evaluation study was supported by a research grant from CareFirst BlueCross BlueShield of Maryland.

Compliance with Ethical Standards

All research protocols, focus group moderator guides and data collecition instruments were approved by the GMU Instituional Review Board. Each participant gave informed consent for the interview and audio-recording.

Conflict of Interest

Dr. Want is an employee of the Peterson Center on Healthcare and Want Healthcare LLC. Mr. Hough is an employee of Alan Newman Research. Dr. Nichols discloses receiving honoraria from the following organizations: WC Research, Inc.; Navigant Consulting; Institute for International Research; Kaufman and Conoles, P.C.; Conent, Inc.; and the Center for Corporate Innovation. All other authors declare they have no conflicts of interest.

Supplementary material

11606_2019_5005_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 19 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Gilbert Gimm
    • 1
    Email author
  • Debora G. Goldberg
    • 2
  • Nouran Ghanem
    • 2
  • Sahar Haghighat
    • 2
  • Jay Want
    • 3
  • Dan Hough
    • 4
  • Len M. Nichols
    • 2
  1. 1.Department of Health Administration and PolicyGeorge Mason UniversityFairfaxUSA
  2. 2.George Mason UniversityFairfaxUSA
  3. 3.Peterson Center on HealthcareNew YorkUSA
  4. 4.Alan Newman ResearchRichmondUSA

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