In the ongoing debate on the value of patient-centered medical homes, a new three-year study funded by Independence Blue Cross showed reduced costs and utilization for high-risk patients cared for by patient-centered medical homes, according to an article in the March edition of The American Journal of Managed Care.
The authors of the study observed that “A number of previous studies have shown early promise for the PCMH model as a vehicle for controlling costs and improving the quality of healthcare delivered by primary care practices” but after reviewing other studies, they decided to focus on high-risk patients.
Among the several other studies they reviewed, according to the authors, “…one study noted that virtually all of the growth in expenditures for Medicare over the period from 1987 to 2002 occurred among beneficiaries with 5 or more chronic illnesses; another paper noted that only 10% of Medicare beneficiaries accounted for 70% of healthcare costs.”
As a result, their study was designed to “assess the impact of PCMH adoption on the patients identified as having the greatest health risks.” This approach supports what some experts have said: That the PCMH model may best serve patients with chronic diseases.
The authors, all employees of Independence Blue Cross, studied nonpediatric PCMH and non-PCMH practices with respect to healthcare costs and utilization during the period from 2009 to 2011.
The patient-centered medical home study found that a group of high-risk patients treated in PCMH practices had fewer hospital admissions than the matched control patients not treated in medical homes in all 3 program years, amounting to reductions of 61, 48, and 94 hospitalizations per 1000 patients. In the first 2 program years, these reductions were accompanied by a savings in inpatient costs ($115 Per Member Per Month (PMPM) in 2009 and $62 PMPM in 2010). Cases had an adjusted total savings of $107 PMPM in 2009, representing an 11.2% reduction from baseline. For 2010, the difference was $75 PMPM, corresponding to a 7.9% reduction.
While total medical costs decreased, the study reported that there were areas in which high-risk patients in PCMH practices experienced increases in costs and utilization. This cohort saw a statistically significant increase in specialist visits in 2009, and corresponding increases in PMPM spending for specialist care in 2009 and 2010.
Contrast with JAMA Patient-Centered Medical Home study
This result was a contrast to the recently reported Rand study reported in JAMA, which found that the practices in the same demonstration project (Pennsylvania’s Chronic Care Initiative) did little to reduce costs and utilization or improve the quality of care over a 3-year period.
In commenting on the contrast between the two studies, Marci Nielsen, PhD, chief executive of the Patient-Centered Primary Care Collaborative, a Washington-based stakeholder group for PCMHs, pointed out that the JAMA paper didn’t distinguish between such patients, and therefore it was unlikely to show a change.
“If you look at the whole population, it is difficult to experience a significant change in spending because the bulk of those patients don’t spend much money to start with,” Nielsen said. “You look at the folks who see docs often, and that’s where you expect to see a change.”
In summarizing, the AJMC study authors felt that there were two take-away points from the study for healthcare professionals to consider:
- Costs and utilization did not significantly differ between PCMH and non-PCMH groups among all patients, suggesting that the benefits of the PCMH model are concentrated among high-risk, high-cost patients.
- PMCH cost reductions seemed to be driven by lower rates of hospitalization, and total costs fell even though utilization of specialist care saw significant increases in the first 2 years.
The authors pointed out that “high-risk members are the most costly to health plans, so it logically follows that the most benefit can be gained by targeting these members with programs such as the medical home.”
What this study means to your practice:
- This study does confirm that medical home works – but the evidence from this study supports that it was the high-risk patients that benefited
- Other studies show that medical home benefits patients that are not just considered high-risk
- Even if only high-risk patients get a benefit from medical home there will be significant cost savings related to providing medical home services for those high risk patient types
- Health plans and ACOs will continue to seek out primary care practices that are recognized as Patient-Centered Medical Homes
- There will continue to be higher payments and incentives paid to providers that practice in a Medical Home and providers will continue to seek new and better ways to become recognized by certifying organizations such as NCQA
The best way to become recognized as an NCQA Medical Home is to use software that has been pre-validated and that is Meaningful Use Stage 2 certified. MediTouch is just one of a few vendors that meet these criteria.
For further discussion of these key studies along with an overview of the PCMH model, register now for our webinar, The Patient-Centered Medical Home: What You Need to Know, on April 10.