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.

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