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.

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