Challenges and strategies in serving the uninsured in Nashville, Tennessee

The patient-centered medical home (PCMH) is being promoted as a cornerstone for transforming primary care. Physician organizations (POs) are playing a more prominent role by facilitating practices' transformation to PCMH. Using a framework of organizational integration, we investigate the changing relationship between POs and practices through qualitative interviews. Through increased integration, POs can support both the big-picture and day-to-day activities of practice transformation. Most PO-practice unit connections reflected new areas of engagement-competencies that POs were not developing in the past-that are proving integral to the broad-scale practice change of PCMH implementation.