Medical homes require more than an EMR and aligned incentives.

Background: The Veterans Health Administration (VHA) is changing its primary care delivery by implementing the patient-centered medical home (PCMH).

Objectives: To evaluate PCMH implementation among 22 newly formed teams working in the VHA.

Study Design: Longitudinal formative evaluation of team members' role transformation during the first 18 months of implementation.

Methods: We used 3 sequential, semistructured focus groups to gather data from 4 different groups representing the principal team member roles: primary care providers, registered nurse care managers, licensed practical nurses, and clerical associates.

Results: Team members identified within-team role and interpersonal conflict, as well as discordant administrative leadership styles, as key implementation challenges.

Conclusions: Our results suggest that, in addition to technological and fiscal infrastructure, healthcare leaders implementing the PCMH model must take into account interprofessional issues associated with changes in leadership and the adoption of team-based structures.