PCMH Pilot Not Associated with Cost Reductions, Study Shows

Cheryl Clark, for HealthLeaders Media , February 27, 2014

A study of a three-year multi-practice patient-centered medical home pilot finds lackluster results. "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," says the study author.

Yet another report showing lackluster quality improvement in physician practices certified as patient centered medical homes—after three years of concerted effort—sparks the question: why is it so difficult to get better results?

The report, published in Wednesday's Journal of the American Medical Association, compared quality, utilization, and costs of care delivered to about 120,000 patients in 32 Pennsylvania practices. About half of the patients were treated by physicians in PCMHs certified or recognized by the National Committee for Quality Assurance; the others were treated by physicians in traditional practices.

The 2008–2011 report found that compared with traditional practices, recognized NCQA PCMHs did no better at controlling costs, or on 10 of 11 quality measures evaluated, such as cholesterol testing and cervical cancer screening, or in avoiding emergency room visits of patients who could have been seen in an ambulatory setting.

The only measure where some improvement was seen in the medical home groups was in nephropathy screening for kidney disease in patients with diabetes.

Though these pilot practices were able to achieve NCQA certification and adopted registries designed to identify patients in need of certain chronic disease services, that didn't result in fewer patients making trips to the emergency department or fewer patients getting admitted to the hospital.

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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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