PCMH Pilot Not Associated with Cost Reductions, Study Shows

Cheryl Clark, for HealthLeaders Media , February 27, 2014

More Time May Be Needed
"It turns out that taking the patient-centered medical home concept out into the real world is a whole 'nother kettle of fish," says Mark Friedberg, MD, a RAND Corporation scientist and practicing internist at Brigham and Women's Hospital. Friedberg is the study's lead author.

"When you take a system [primary care] that's already under stress and potentially apply even more stress by asking it to transform, it may not be able to respond as you hope, especially over the short time period that most pilot projects run, and this one ran much longer, three years."

He adds that results from this and several other trials show that changing physicians' behavior to do more for their patients outside the office, with reminders and communication and follow-up, "is just really hard to do. And we're now concerned that medical home transformations may not really achieve the goals set out for them at the rapid pace that people have hoped."

It may, in fact, take a lot longer than three years, he says.

In an accompanying editorial, Thomas Schwenk, MD, of the University of Nevada School of Medicine in Reno and Las Vegas, wrote that the PCMH model has been held up as "the foundation for all primary care delivery, including the solo and small group practices that dominate the primary care delivery system."

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6 comments on "PCMH Pilot Not Associated with Cost Reductions, Study Shows"

Tia McClung (3/12/2014 at 9:16 AM)
A close evaluation of the article gleans that the research period of 2008-2011 is not reflective of the current model of PCMH that is accredited by NCQA. The Level 2 accreditation has a gross disparity to the Level 3 accreditation and practices that had the former recognition find that they truly lack the standards, best practices and the rigid benchmarks and outcomes that the latest accreditation requires. Level 2 provider groups that strive for accreditation within the current highest recognition can speak to the rigor and change that occurs with the Level 3 accreditation. Most likely, a pilot study with date ranges of 2011-2014 will provide some positive key messaging re: the value of the Patient Centered Medical Home.

Michele Bordelon (3/5/2014 at 3:31 PM)
Until PCMH's utilize a strong patient engagement piece (e.g. regular coaching for lifestyle change and wellness management) this will not change.

R Libby (3/3/2014 at 3:23 PM)
There are mountains of data supporting the impact of patient centered medical homes on decreasing cost and improving outcomes, looking at more diverse and significantly larger patient populations than cited in the JAMA article. The process of being certified as a patient centered medical home is nothing but an exercise in developing a small part of the process necessary to transform a primary care (and, hopefully, specialty) practice into one that is capable of managing population health. This does not happen over a 3 year period; it is a learning continuum that evolves as a patient care and business model. It needs the continuing support of payment innovations that help fund its infrastructure, and the collaboration of stakeholders to find more cost efficient alternatives to the current consumer oriented trends of retail health care services, the fee for service margin/volume inspired payment system, and the inflation in overall health care costs by so many of the uncontrollable settings patients may find themselves in. One would hope that the conclusions of the JAMA article were used as a learning tool that can help improve the process, not undermine it.




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