Patient-Centered Medical Homes Show Little Benefit

A patient-centered medical home (PCMH) demonstration project did little to reduce costs and utilization or improve the quality of care, according to a new study.

Researchers at the RAND Corporation (Boston, MA, USA), the University of Pennsylvania (Philadelphia, USA), and other institutions conducted a study of 32 primary care practices participating in the pilot Southeastern Pennsylvania Chronic Care Initiative, comparing their structural capabilities at the pilot’s beginning and end. The researchers used claims data from four participating health plans, comparing yearly changes in the quality, utilization, and costs of care delivered to 64,243 patients who were attributed to pilot practices, and 55,959 control patients attributed to 29 comparison practices.

The researchers measured performance on 11 quality measures for diabetes, asthma, and preventive care; utilization of hospital, emergency department (ED), and ambulatory care; and standardized costs of care. The results showed that participation was associated with statistically significantly greater performance improvement, relative to comparison practices, on just 1 of the 11 investigated quality measures: nephropathy screening in diabetes. Pilot participation was not associated with statistically significant changes in utilization or costs of care. The study was published on February 26, 2014, in JAMA.

“The practices adopted structural changes to their work. However, those changes did not create statistically significant reductions in cost or utilization measures, such as hospitalization, that PCMH’s strive to create,” concluded lead author Mark Friedberg, MD, MPP, of the RAND corporation, and colleagues. “The research should be alarming to backers of the delivery model who claim the PCMH design is the future of primary care delivery. These findings suggest that medical home interventions may need further refinement.”

The Pennsylvania Chronic Care Initiative is a partnership that includes insurers, health systems, provider organizations, educational institutions, and government agencies. The model includes several key components: Emphasizing the patient's central role in managing their illness; changing the way providers deliver care, on a daily basis, for their patients with chronic disease so that they can track these patients and make sure they are getting the care they need when they need it, based on proven medical evidence; using data to monitor health outcomes of patients; creating financial incentives to help providers implement case management, by facilitating agreement among payers on benchmarks and appropriate rewards, and forming partnerships with community organizations to help people improve their health.

Related Links:
RAND Corporation
University of Pennsylvania