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Medical home pilot fails to reduce cost, utilization
Major finding: Primary care practices in the medical home pilot performed significantly better on only 1 of 11 measures.Data source: Researchers...
The keys to a successful medical home may be the incentives added to the structural changes made to a practice.
“Medical home interventions that incentivize activities in addition to structural transformation may produce larger improvements in patient care,” Dr. Mark W. Friedberg of the RAND Corp. and his colleagues wrote in study published June 1 in JAMA Internal Medicine.
Dr. Friedberg and colleagues examined performance on six quality measures for diabetes care and cancer screening, as well as use of hospital, emergency department, and ambulatory care, comparing the northeast region of the Pennsylvania Chronic Care Initiative (PACCI) with the rest of the network. Unlike other PACCI regions, practices in the northeast region were eligible for shared savings – but no penalties – based on meeting quality benchmarks.
By the third year, participating practices were “statistically significantly associated with lower rates of all-cause hospitalization per 1,000 patients per month, all-cause emergency department visits, ambulatory care–sensitive emergency department visits, and ambulatory visits to specialists, and with higher rates of ambulatory primary care visits,” Dr. Friedberg and his colleagues wrote (JAMA Intern. Med. [doi:10.1001/jamainternmed.2015.2047]).
Dr. Mark W. Friedberg
They suggested the improvements were because of the shared savings bonuses, regular feedback on utilization, and lack of an early-achievement incentive. Together, those factors “potentially [enhanced] participating practices’ abilities to focus on learning collaborative activities and other process improvement efforts.”
The researchers called for additional studies “to determine empirically whether these features or others are indeed the key ‘active ingredients’ in medical home interventions. Continuing experimentation and careful evaluation of the features of medical home interventions can inform the design of future programs intended to strengthen primary care.”
The study was sponsored by the Commonwealth Fund.
