Patient-Centered Medical Homes Reduce Costs for Medicare Patients
Medicare costs for patients receiving care from PCMHs
grew slower than for other Medicare patients, rates for emergency room
visits, acute care hospitalizations lower, too
Stephanie Stephens, HBNS Contributing Writer
The PCMH emphasizes personal relationships, team
care, coordination across specialties and care settings, quality
and safety improvement, and open access.
Learn more about PCMH care below news report.
Aug. 1, 2014 - The patient-centered medical home (PCMH),
introduced in 2007, is a model of health care that emphasizes personal
relationships, team delivery of care, coordination across specialties
and care settings, quality and safety improvement, and open access. As
the number of PCMHs has increased, a new report in the journal Health
Services Research finds the model offers a promising option to
reduce health care costs and utilization of some health care services.
“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 corresponding study author, Martijn van
Hasselt, Ph.D., of the nonprofit RTI International in Research Triangle
“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
The study examined patterns of health care 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 to date.
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,” he
“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 E.R. 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 health care 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.”
(Information from Agency for
Healthcare Research & Quality, U.S. Department of Health & Human
The medical home model holds
promise as a way to improve health care in America by transforming how
primary care is organized and delivered. Building on the work of a large
and growing community, the Agency for Healthcare Research and Quality (AHRQ)
defines a medical home not simply as a place but as a model of the
organization of primary care that delivers the core functions of primary
The medical home encompasses five
functions and attributes:
1. Comprehensive Care
care medical home is accountable for meeting the large majority of each
patient’s physical and mental health care needs, including prevention
and wellness, acute care, and chronic care. Providing comprehensive care
requires a team of care providers. This team might include physicians,
advanced practice nurses, physician assistants, nurses, pharmacists,
nutritionists, social workers, educators, and care coordinators.
Although some medical home practices may bring together large and
diverse teams of care providers to meet the needs of their patients,
many others, including smaller practices, will build virtual teams
linking themselves and their patients to providers and services in their
The primary care medical home
provides primary health care that is relationship-based with an
orientation toward the whole person. Partnering with patients and their
families requires understanding and respecting each patient’s unique
needs, culture, values, and preferences. The medical home practice
actively supports patients in learning to manage and organize their own
care at the level the patient chooses. Recognizing that patients and
families are core members of the care team, medical home practices
ensure that they are fully informed partners in establishing care plans.
The primary care medical home
coordinates care across all elements of the broader health care system,
including specialty care, hospitals, home health care, and community
services and supports. Such coordination is particularly critical during
transitions between sites of care, such as when patients are being
discharged from the hospital. Medical home practices also excel at
building clear and open communication among patients and families, the
medical home, and members of the broader care team.
The primary care medical home
delivers accessible services with shorter waiting times for urgent
needs, enhanced in-person hours, around-the-clock telephone or
electronic access to a member of the care team, and alternative methods
of communication such as email and telephone care. The medical home
practice is responsive to patients’ preferences regarding access.
The primary care medical home
demonstrates a commitment to quality and quality improvement by ongoing
engagement in activities such as using evidence-based medicine and
clinical decision-support tools to guide shared decision making with
patients and families, engaging in performance measurement and
improvement, measuring and responding to patient experiences and patient
satisfaction, and practicing population health management. Sharing
robust quality and safety data and improvement activities publicly is
also an important marker of a system-level commitment to quality.
AHRQ recognizes the central role of
health IT in successfully operationalizing and implementing the key
features of the medical home. Additionally, AHRQ notes that building a
primary care delivery platform that the Nation can rely on for
accessible, affordable, and high-quality health care will require
workforce development and
fundamental payment reform.
To view a list of foundational
articles on the PCMH click
Without these critical elements,
the potential of primary care will not be achieved.
Patient-Centered Primary Care Collaborative -
http://www.pcpcc.org/ - reports to be the leading national coalition
dedicated to advancing the patient-centered medical home.
Founded in 2006, the Patient-Centered Primary Care
Collaborative (PCPCC) is dedicated to advancing an effective and
efficient health system built on a strong foundation of primary care and
the patient-centered medical home (PCMH).
The PCPCC achieves its mission through the work of
our five Stakeholder Centers, led by experts and thought leaders who are
dedicated to transforming the U.S. health care system through delivery
reform, payment reform, patient engagement, and employee benefit
redesign. Today, PCPCC’s membership represents more than 1,200 medical
home stakeholders and supporters throughout the U.S.
Very good explanation of the
Patient Centered Medical Home concept is available on their video...
click here to watch
The Medical Home officially began in 2007…
explanation of the Patient Centered Medical Home concept
is available on this video...
click here to watch
"each patient has an ongoing relationship with a personal
physician trained to provide first contact, continuous and
Physician directed medical practice:
"the personal physician leads a team of individuals at the
practice level who collectively take responsibility for the
ongoing care of patients."
Whole person orientation:
"the personal physician is responsible for providing for all
the patient’s health care needs or taking responsibility for
appropriately arranging care with other qualified
Care is coordinated and/or integrated: Care
is coordinated and/or integrated between complex health care
systems, for example across specialists, hospitals, home
health agencies, and nursing homes, and also includes the
patient’s loved ones and community-based services. This goal
can be attained though the utilization of registries, health
information technology and exchanges, ensuring patients
receive culturally and linguistically appropriate care.
Quality and safety
Partnerships between the patient,
physicians and their family are an integral part of the
medical home. Practices are encouraged to advocate for
their patients and provide compassionate quality,
Guide decision making based on evidence
based medicine and with the use of decision-support
Physician’s voluntary engagement in
performance measurements to continuously gauge quality
Patients are involved in decision making
and provide feedback to determine if their expectations
Utilization of informational technology
to ensure optimum patient care, performance measurement,
patient education, and enhanced communication
At the practice level, patients and
their families participate in quality improvement
Enhanced access to care is available through
open scheduling and extended hours and new options for.
Payment must "appropriately recognize the
added value provided to patients who have a patient-centered
Payment should reflect the time
physician and non-physician staff spend doing
patient-centered care management work outside the
Services involved with coordination of
care should be paid for
It should support measurement of quality
and efficiency with the use and adoption of health
Enhanced communication should be
It should value the time physicians
spend using technology for the monitoring of clinical
Payments for care management services
should not result in deduction in payments for
Payment "should recognize case mix
differences in the patient population being treated
within the practice"
It should allow physicians to share in
the savings from reduced hospitalizations
allow for additional compensation for achieving
measurable and continuous quality improvements
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