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PCMH model not yet delivering on promise


Analysis of data at one of the nation's largest Patient-centered Medical Home pilots finds limited improvements in costs and patient outcomes.

A new study of one of the nation’s largest Patient-centered Medical Homes (PCMH) pilots shows that the PCMH model has yet to deliver on its promise of lowering medical costs and improving outcomes for chronically ill patients.

A team of researchers from the RAND Corporation, Harvard Medical School, the University of Pennsylvania and others studied changes in the quality, utilization, and cost of care provided by 32 small and medium-sized medical practices in a pilot PCMH in southeastern Pennsylvania. They examined performance data on 11 quality measures for diabetes, asthma, and preventive care, as well as changes in hospital and emergency department use, and costs of care.

After examining three years of data-from June 2008 through May 2011-the researchers found improvement in one quality measure-nephropathy screening in diabetes. They found no changes in hospital or emergency department usage or the cost of care.

“We were a little surprised by the findings, mainly because expectations of the medical home concept

Mark W. Friedberg, MD, MPPhave been very high,” Mark W. Friedberg, MD, MPP, a scientist at RAND and the study’s lead researcher tells Medical Economics. “Based on the strength of evidence of how important primary care is to overall patient health and the quality and efficiency of care, we expected to see more of an effect than we did at this particular pilot.”

The research team also compared data from the PCMH practices with data from 29 similarly sized practices in the region that were not part of the pilot. They found no significant differences between the two groups in any of the areas measured.

Friedberg cautions that the study’s findings shouldn’t be interpreted to mean that the PCMH model can’t work. “It’s really just to say there’s not guarantee that all attempts to implement the model are going to meet the high expectations for it,” he says.


Other studies have shown improvements in outcome and lowered costs in PCMH settings. In July 2013 Independence Blue Cross (IBC) announced results of a series of studies of PCMHs in Pennsylvania. The studies found significant reductions in medical costs for patients with chronic conditions treated in primary care practices that had been transformed into medical homes, especially among patients with diabetes. Those patients saw a 44% reduction in hospital costs and a 21% reduction in overall medical costs.

Diabetic patients treated in the studied PCMHs also saw a 60% improvement in getting their low-density lipoprotein levels under adequate control. Overall, the number of patients with poorly controlled diabetes declined by 45%, according to IBC.

Friedberg notes that research on PCMHs is continuing, both by his team and others. “Once we have results from these (studies) we’ll be able to look at those that performed better and those that performed less well, and deduce in a quantitative way what seems to make a difference,” he says.

Results of the RAND study were published in the February 26, 2014 issue of the Journal of the American Medical Association.


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