The patient-centered medical home (PCMH) is a model of healthcare that is based around a physician network, the sharing of medical records, and the coordinated care of patients. However, instead of a hospital or a large physician group of providers, this model is centered on primary care physicians who find ways to contract with other patient care organizations for services. A recent study in the journal Health Services Research has concluded that costs are reduced and rates of emergency room visits seem to be lower for Medicare beneficiaries who receive care from PCMHs than other patients. (For more information on PCMHs, read “Alternative Healthcare Delivery Models and O&P ,” in the January 2014 issue of The O&P EDGE.)
“When we looked at the literature, we found that the overall evidence is still fairly limited in terms of how well the model actually works,” said study co-author, Martijn van Hasselt, PhD, an associate professor with the Department of Economics at the University of North Carolina at Greensboro. “Among the more consistent findings is that PCMHs tend to be associated with improved quality of care and better patient experience with care. Evidence remains fairly mixed, however, with respect to the cost of care, hospital admissions, or emergency room visits.”
The study examined patterns of healthcare use and expenditures for Medicare fee-for-service beneficiaries from a sample of PCMHs recognized by the National Committee for Quality Assurance (NCQA) and a set of practices without that designation. The use of a standard definition of a PCMH, with auditing by NCQA, has been lacking in many of the published studies on PCMHs.
The research team used data collected from fee-for-service beneficiaries between 2007 and 2010. “We thought that if any effect was present, it would likely be seen in the Medicare population, and in particular for patients who are in poorer health,” van Hasselt said. “The total Medicare expenditure side actually grew at a slower rate for patients who received care from a medical home versus not. Costs also seemed to be lower for acute care hospitalizations when patients had received care from a medical home, and the number of [emergency room] visits also declined relative to the comparison group of patients.”
Researchers found that overall hospital admissions did not decline. “We believe that warrants future research,” van Hasselt said. “Maybe medical home patients get steered toward lower-cost hospitals, or when people do end up at a hospital, those receiving care from medical homes tend to have less severe conditions so that overall expenditures are lower.” Notably, the decline in healthcare costs was larger for practices with sicker than average patients, primary care practices, and solo practices.
An ongoing debate exists about the impact of the patient-centered medical homes on costs of care, said Sarah Scholle, DrPH, NCQA’s vice president of research and analysis. “This study adds to the evidence suggesting that patient-centered medical homes can reduce costs of care, but how do they achieve savings? There isn’t a single clear answer.”
The study points to reduced emergency department visits and more effective management of sicker patients, as do other studies, she said. “This report also suggests that lower average payments to hospitals used by PCMH patients is a factor. The findings point to the importance of considering how PCMHs function in the context of a ‘neighborhood’ of providers and facilities.”
Editor’s note: This story was adapted from materials provided by Health Behavior News Service, part of the Center for Advancing Health.
