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PCMH Evaluations Show Reduced Costs, Improved Health


A majority of recent studies on the patient-centered medical home reported decreased cost of care and a reduction in the use of unnecessary and/or avoidable services.

A majority of recent studies on the patient-centered medical home (PCMH) reported decreased cost of care and a reduction in the use of unnecessary and/or avoidable services.

The report The Patient-Centered Medical Home’s Impact on Cost & Quality: An Annual Update of the Evidence, 2012-2013 from the Patient-Centered Primary Care Collaborative (PCPCC)and the Milbank Memorial Fund analyzed outcomes across 20 evaluations (13 peer-review and seven industry-generated evaluations).

“The research here suggests that when fully transformed primary care practices embrace this model of care, we can expect a number of consistent, positive outcomes across a number of clinical and financial measures,” said Marci Nielsen, PhD, MPH, chief executive officer of the PCPCC, said in a statement. “The PCMH has undergone an impressive expansion over the last several years, reaching across all corners of the health care marketplace, from health plans to federal agencies, from employers to state Medicaid programs.”

Approximately 60% of PCMH studies revealed a reduction in emergency department (ED) or urgent care visits, and 30% of studies showed improvements in population health indicators (better controlled HbA1c, blood pressure and LDL levels) and increases in screening and/or immunization rates. A quarter of peer-reviewed studies and 14% of industry-generated studies reported an improvement in patient satisfaction.

However, the consistency of PCMH’s effects can vary greatly state by state across studies and settings, according to PCPCC.

For instance, in the Colorado Multi-Payer PCMH Pilot, 85% of patients said care of well organized and efficient and 97% said they would recommend it to family and friends. Colorado’s program also reported 15% fewer ED visits and for every dollar invested the estimated return ranged from 2.5:1 to 4.5:1.

In Michigan, the BlueCross BlueShield of Michigan Physician Group Incentive Program reported that practices with full PCMH implementation had a savings of $26.37 per member per month. In New York, WellPoint’s Single Health Plan Model New York PCMH reported 11% fewer ED visits for adults compared to the control group.

However, in New Jersey’s single-year study of the Horizon BlueCross BlueShield New Jersey Single Private Payer Pilot, health care utilization and costs did not significantly change. And while the Rhode Island Chronic Care Sustainability Initiative reported fewer overall ED visits, inpatient admissions and ambulatory care sensitive inpatient admissions, it was not a statistically significant decrease.

See the full report.

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