Total Cost of Care Lower among Medicare Beneficiaries Receiving Care from PCMHs

In recent months nine different studies have shown that PCMH recognition resulted in reductions in emergency department visits and/or hospitalization (NCQA, 9/3/14).  The latest of these studies appeared in the Health Services Research Journal article titled Total Cost of Care Lower among Medicare Fee-for-Service Beneficiaries Receiving Care from Patient-Centered Medical Homes. The study was conducted by RTI International.

The purpose of this study was to compare health care utilization and costs of care between practices with and without NCQA PCMH recognition. Using the Medicare Fee-for-Service program, the authors compared 308 PCMHs with NCQA recognition to a sample of almost 2,000 non-accredited PCMHs over three years.

The main finding from the study was, “Relative to the comparison group, total Medicare payments, acute care payments and emergency room visits declined after practices received NCQA accreditation. The decline was larger for practices with sicker than average patients, for primary care practices and for solo practices.” In addition, accredited practices saw a five percent greater reduction in the trend of total Medicare payments than their non-accredited counterparts.

The results of this study reinforce a growing body of evidence that PCMH recognition is most effective for patients with chronic conditions, and that it may have a correlation with lower health care costs and utilization.

Click here to read the abstract and access the complete article.  (There may be a fee for the complete article.)

Article citation: Health Services Research, Van Hasselt et al, Total Cost of Care Lower among Medicare Fee-for-Service Beneficiaries Receiving Care from Patient-Centered Medical Homes, July 2014.

Structural Capabilities in Small and Medium-Sized Patient-Centered Medical Homes

The American Journal of Managed Care article Structural Capabilities in Small and Medium-Sized Patient-Centered Medical Homes describes the first study to look at structural capabilities and change over time in small- to medium-sized primary care practices participating in Patient-Centered Medical Homes (PCMH) pilots.  The authors examined the structural capabilities of 30 pilot projects and change over time in five Rhode Island pilot projects. Their findings show that small- and medium-size primary care practices are able to achieve a high level of medical home capability.

The study used the National Committee for Quality Assurance’s Physician Practice Connections—Patient-Centered Medical Home (PPC-PCMH) accreditation survey data to determine that:

  • On average, practices earned a total score of 73 points (out of 100) for their structural capabilities at baseline.
  • High- and low-performing practices differed most in their achievement on electronic prescribing, patient self-management, and care management standards.
  • Rhode Island practices had an average score of 42 points at baseline and 90 points after 24 months.
  • Building structural capabilities requires attention to payment reform, implementation and cultural change.

Approaches that facilitated PCMH achievement included payment incentives, “transformation coaches,” learning collaboratives, and data availability to support performance management and quality improvement.  Conditions that hindered PCMH achievement included the extent of transformation required, technology shortcomings, slow cultural change, change fatigue, and lack of broader payment reform.

Small- and medium-sized practices, currently working on achieving PCMH accreditation should be encouraged by these findings. Providers will want to review the description of the approaches that facilitate and hinder PCMH achievement to determine if any changes are needed for their own practices.

Click here to read the entire AJMC article.

How Do Patient-Reported Measures Contribute to Value in Health Care?

The use of patient-reported measures is the subject of a recent Institute for Healthcare Improvement (IHI) article titled How Do Patient-Reported Measures Contribute to Value in Health Care? The article is based on an interview by IHI Vice President Kathy Luther with IHI Communications Specialist Jo Ann Endo.  Ms. Endo discusses the potential for patient-reported measures (PRMs) to catch direct input from patients to improve care delivery and assist organizations to develop value-based systems.

Highlights from the article include:

  • PRMs provide the patient’s perspective on their health status.  PRMs are different from other types of standardized data collection tools because they ask patients specific questions related to their condition and their life at the time of the interview.
  • PRMs require baseline data through questions that obtain information on how the patient is functioning before treatment or interventions.  Following treatment or interventions the patient is then questioned at regular intervals on the same PRMs.
  • Collecting PRMs from patients with similar conditions, over time, allows providers to learn what works and what doesn’t in patient care.  This information enables providers and patients to make informed treatment decisions.
  • The challenge to using PRMs is that the data needs to be collected over time.  This requires health care organizations to have a long term relationship patients and embed tools and procedures into normal procedures.

Use of PRMs is relatively new in the U.S. but it has been used extensively and successfully in Europe.  PRMs don’t easily fit into the U.S. fee-for-service system but this type of data will be crucial as population health and value-based health care become the norm.

Click here to learn more and read the article at IHI.

Patient-Centered Medical Home Initiative Produced Modest Economic Results For Veterans Health Administration, 2010–12

In 2010 the Veterans Health Administration (VHA) began a nationwide initiative called Patient Aligned Care Teams (PACT) that reorganized care at all VHA primary care clinics in accordance with the patient-centered medical home model. The researchers in this article published in Health Affairs analyzed data for fiscal years 2003–12 to assess how trends in health care use and costs changed after the implementation of PACT. They found that PACT was associated with “modest increases in primary care visits and with modest decreases in both hospitalizations for ambulatory care–sensitive conditions and outpatient visits with mental health specialists.” The researchers found that the PACT model did not produce a positive return on investment in terms of the cost, but they noted that “trends in costs and use are favorable. Adopting patient-centered care does not appear to have been a major financial risk for the VHA.”

As stated by the authors of the article, “An organization’s decision to adopt the patient-centered medical home model should be based not upon unrealistic expectations of substantial cost savings but upon expected benefits, such as improved quality of care and high satisfaction with care. Over time, however, there may well be incremental savings.” This statement about ROI versus quality of care is a consistent thread throughout the latest PCMH impact research.

Click here to access the full article published in the June issue of Health Affairs.

The Medical Home’s Impact on Cost & Quality

This annual report from the Patient Centered Primary Care Collaborative highlights recently published clinical, quality, and financial outcomes of patient-centered medical home (PCMH) initiatives from across the United States. Profiling a showcase of PCMH initiatives, this report focuses on studies released between August 2012 and December 2013 and identifies where they are happening, who is leading them, and highlights the outcomes they are achieving. In addition to the results from these 21 most recent studies, the report includes a summary of PCMH initiatives taking place throughout the US since 2009.   A summary of key points from this year’s report include:

  • PCMH studies continue to demonstrate impressive improvements across a broad range of categories including: cost, utilization, population health, prevention, access to care, and patient satisfaction, while a gap still exists in reporting impact on clinician satisfaction.
  • The PCMH continues to play a role in strengthening the larger health care system, specifically Accountable Care Organizations and the emerging medical neighborhood model.
  • Significant payment reforms are incorporating the PCMH and its key attributes.

Of particular interest is the Appendix A: Summary of PCMH evidence by category and organized by state/location from 2009-2013. This section examines whether the PCMH initiative demonstrated one or more of the following:

  • Cost reductions
  • Reduction in ED/hospital
  • Improved health
  • Improved access to care
  • Increased preventative services
  • Improved patient or clinician satisfaction

Click the link to access the full report:

A Medical Home Investment Achieves a Double-Digit ROI

bon secoursIn this recently published article, Robert Fortini of Bon Secours Virginia Medical Group describes how they transformed their care model using principles of PCMH and population health management, with an eye on payment reform.  The results are striking, including quality improvements and a double-digit return on investment.

Read the article here.


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The Oregon ACO Experiment — Bold Design, Challenging Execution

Shared by Mark Pugh, Goochland Free Clinic:  An interesting article from NEJM on Oregon Health Plan and their implementation of ACO’s. The Oregon ACO Experiment — Bold Design, Challenging Execution

Click PCMH Impact Research in the top menu to browse more studies and evaluations.

A Pharmacist Visit Improves Diabetes Standard in a Patient Centered Medical Home

Shared by Cathy Wheeler, Fan Free Clinic:   Article from the American Journal of Medical Quality, A Pharmacist Visit Improves Diabetes Standard in a Patient Centered Medical Home

Click PCMH Impact Research in the top menu to browse more studies and evaluations.

Comparison between Nurse Practitioners and MD Providers in Diabetes Care

Shared by Cathy Wheeler, Fan Free Clinic: Interesting article in The Journal for Nurse Practitioners “Comparison between NP and MD Providers in Diabetes Care.”

Click PCMH Impact Research in the top menu to browse more studies and evaluations.

New Evidence for PCMH from Large-Scale Study in New York

The evidence base for PCMH is growing as more projects are conducting and publishing detailed evaluations.  A new study from Empire Blue Cross and Blue Shield is particularly important because it compares a large group of patients in a PCMH environment to a large control group of patients in non-PCMH practices.  The results are compelling, as PCMH practices were associated with better preventive health, higher levels of disease management, and lower resource utilization and costs compared with practices not pursuing PCMH status.

  • The study included 31,032 PCMH and 350,015 non-PCMH patients.
  • Among PCMH-treated patients, diabetics had higher rates of glycated hemoglobin testing; cardiovascular disease patients had higher rates of testing and better low-density lipoprotein cholesterol control; imaging rates for low back pain were lower; among pediatric patients, inappropriate antibiotic use for nonspecific or viral respiratory infections was lower.
  • PCMH-treated adults and children had 12% and 23% lower odds of hospitalization, and required 11% and 17% fewer ED services, respectively, than non-PCMH patients.
  • Risk-adjusted total per member per month costs were 8.6% and 14.5% lower for PCMH-treated pediatric and adult patients, respectively (P <.01).

There are at least two important implications of this research for community health centers pursuing PCMH.  First, this is important new evidence of the potential value of the PCMH model.  Second, this study foreshadows how PCMH performance is likely to be measured by payers include Medicare, Medicaid, and private plans.  As you are building out your PCMH capacity, think about how you might produce the kinds of performance metrics outlined in this study (diabetes testing, cardiovascular disease testing, etc.)  Those that have these kinds of metrics will have a competitive advantage in the new environment of patient-centered care.

Click here to read the full study at the American Journal of Managed Care

Click PCMH Impact Research in the top menu to browse more studies and evaluations.