The Dissenter's Viewpoint: There Has to Be a Better Way to Measure a Medical Home.

The patient-centered medical home (PCMH) is widely touted as the current pathway to high-quality primary care practice. Many payers and institutions are using the formal National Committee for Quality Assurance (NCQA) PCMH tool to evaluate practices. Practices commonly feel pressured financially to achieve NCQA recognition. As 2 small high-functioning innovative primary care practices, we describe the actual process of using this tool and assess its utility using a framework based on patient experience of care, costs, and population health. We both attained certification as Level 3 PCMHs but conclude that NCQA's tool mismatches form and function, is costly and wasteful, and may succeed more in documentation of policies than in supporting improved outcomes in practices.