PCMH Pilot Not Associated with Cost Reductions, Study Shows

Cheryl Clark, for HealthLeaders Media , February 27, 2014

The main obstacle to improved performance, he says, is the apparent difficulty physicians have in redistributing workload in their practices. "They were socialized that the physician does everything, that they're the captain of their ship," Crabtree says.

"Medical school does that to them. But now there is the reluctance among some physicians to give up autonomy. They need to have a more distributed leadership style."

Care coordinators need to work with nurse practitioners, physicians, and others in the practice. And they need to have certain skill sets, formalized training programs for which do not yet exist.

"Most of the places that are really successful at this are training their own people, but that's not a very viable model for broad dissemination," Crabtree says.

Friedberg says that the researchers were "surprised" at the lackluster results from this three-year study because these practices that were patient-centered medical homes were large, and had been among the longest running PCMH model practices in the country.

In summary, Friedberg says that the study demonstrates loud and clear that doctors and policy makers "are still really new at this. It's not an area where we've had a lot of experience, and so we're definitely still in an experimental phase.

"We really won't know what works until we test it."

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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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