PCMH Pilot Not Associated with Cost Reductions, Study Shows

Cheryl Clark, for HealthLeaders Media , February 27, 2014

But their success has been demonstrated primarily in "highly integrated healthcare systems and single-payer community-based practices."

2 Key Lessons
Advocates for the medical home concept may be disappointed, he added, "but they should pay close attention to the study's lessons."

Friedberg says there are two key lessons from the Pennsylvania project:

"First, it's not a foregone conclusion that transforming and receiving recognition as a medical home will produce all the expected benefits of a medical home. And lesson number 2 is we still need to experiment with the model. It's not that we know what works and we just need to implement it at a bigger scale. This argues that we need to understand how to make this model effective. "

The concept of the patient-centered medical home involves making sure that patients are followed up. For example, patients with diabetes may be called at home if they haven't scheduled an appointment in six months, or invited to speak with a nurse on the phone.

Friedberg pointed to other research he and others conducted on a similar pilot model in Rhode Island, that showed "no significant improvements were found in any of the quality measures." That work was published in September.

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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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