PCMH Pilot Not Associated with Cost Reductions, Study Shows

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.

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.
Steve Wilkins MPH (2/28/2014 at 12:07 PM)

What has always struck me as odd about these pilots is the presumption by plan sponsors that infrastructure modifications like registries, team care, extended hours and embedded care managers would lead to better quality care, increased engagement or exceptional patient experiences. There was never any evidence to support that presumption. Rather, evidence over the last 30 years has shown that the adoption of patient-centered care - which really translates into patient-centered communications - is what leads to improved engagement, better quality outcomes, lower lab test costs, fewer ER visits and hospital readmits and better patient experiences. Yet these softer aspects of patient-centered care are basically ignored by PCMH credentialing agencies. In a recent piece I did on my blog Mind the Gap I described how PCMH providers were no more patient-centered in terms of their patient communication skills than their non-PCMH counterparts. In a comparison with AHRQ's CHAPS data I showed how PCMH satisfaction scores for physician communication were lower for PCMH providers than all physicians most of which don't practice in a PCMH Model practice. As the Founder of the Adopt One! Challenge, which aims to challenge doctors in PCMH and non-PCMH practices to adopt one new patient-centered communication skill in 2014, my research group intends to demonstrate how the lack of patient-centered communications in PCMHs is a major contributing factor in the disappointing outcomes being reported in studies like the one you referenced. Steve Wilkins MPH Mind the Gap www.healthecommunications.wordpress.com
Danny Long (2/27/2014 at 9:51 PM)

I am a 24/7 caregiver for my wife who was left a quad after elective neurosurgery. (botched diagnosis) Our trusted surgery team has refused to talk to us since surgery, records falsified, bla bla bla, nthing new there. Any way, my wife and I both went from fully employed to both unemployed, and I became full time (unpaid) nurse, psychical therapist, etc, while the medical complex take zero responsibility and continue on. Often (like myself) a family member can provide MUCH better care, and it is all done for free. Such a scam for the medical complex. Very sad that I provide MUCH better care for over five years and counting, while going bankrupt, and the hospital who cause this simply count their money touting "World Class Healthcare.
Sue Houck (2/27/2014 at 12:30 PM)

Having been a healthcare provider and spending the last 14 years assisting medical groups implement Medical Home concepts, I've found that culture and financial incentives via reimbursement and physician compensation determine sustainability. As long as most payer reimbursement dollars and physician compensation incentivize volume of care i.e. number of visits vs. value or keeping people healthy we will continue to see incremental vs. transformative change. Ben Crabtree's comments about physician training and culture are spot-on. The culture of care continues to be staff and physician vs. patient centric. The result? Most patients often feel medically homeless.


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