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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

By 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 Park, N.C.

“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 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.

 

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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 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 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.”

News from Health Behavior News Service, part of the Center for Advancing Health. Health Services Research is the official journal of the Academy Health and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust.


What is a Patient Centered Medical Home (PCMH)

(Information from Agency for Healthcare Research & Quality, U.S. Department of Health & Human Services)

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 health care.

The medical home encompasses five functions and attributes:

1. Comprehensive Care

The primary 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 communities.

More about Comprehensive Care

2. Patient-Centered

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.

More about Patient-Centered Care

3. Coordinated Care

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.

More about Coordinated Care

4. Accessible Services

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.

More about Accessible Services

5.Quality and Safety

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.

More about Quality and Safety

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 significant workforce development and fundamental payment reform.

To view a list of foundational articles on the PCMH click here.

Without these critical elements, the potential of primary care will not be achieved.

Learn more about the Patient Centered Medical Home.


Patient-Centered Primary Care Collaborative

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…

Very good explanation of the Patient Centered Medical Home concept is available on this video... click here to watch

In 2007, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association — the largest primary care physician organizations in the United States — released the Joint Principles of the Patient-Centered Medical Home.[5] The principles listed were:

  • Personal physician: "each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care."
  • 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 professionals."
  • 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.[10]
  • 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, patient-centered care
    • Guide decision making based on evidence based medicine and with the use of decision-support tools
    • Physician’s voluntary engagement in performance measurements to continuously gauge quality improvement
    • Patients are involved in decision making and provide feedback to determine if their expectations are met
    • 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 activities.[10]
  • Enhanced access to care is available through open scheduling and extended hours and new options for.[10][25]
  • Payment must "appropriately recognize the added value provided to patients who have a patient-centered medical home."
    • Payment should reflect the time physician and non-physician staff spend doing patient-centered care management work outside the face-to-face visit
    • 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 information technology.[26]
    • Enhanced communication should be supported
    • It should value the time physicians spend using technology for the monitoring of clinical data
    • Payments for care management services should not result in deduction in payments for face-to-face service
    • 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
    • It should allow for additional compensation for achieving measurable and continuous quality improvements

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