Patient-centered medical home shows cost savings potential

Medicare paid less for beneficiaries who received health care services as part of a National Committee for Quality Assurance–recognized patient-centered medical home, compared with those in traditional delivery models, according to new research.

Researchers examined practice-level patterns and costliness of care for Medicare fee-for-service beneficiaries who received medical treatment between July 1, 2007, and June 30, 2010, from one of 308 NCQA-recognized patient-centered medical homes (PCMHs) vs. a comparison group of beneficiaries who received health care from medical practices lacking that recognition. The Centers for Medicare & Medicaid Services funded the study.

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Healthcare payments from NCQA-recognized PCMHs were lower compared to traditional delivery models from 2007-2010.

Baseline health care utilization "was lower among NCQA-recognized PCMHs across all utilization measures used in this study," according to the report, published July 30 online in Health Services Research (2014 [doi:10.1111/1475-6773.12217]). "For example, the number of hospitalizations (per 1,000 beneficiaries) for any condition was 27% lower than in the comparison group (189 vs. 258), whereas emergency department visits (per 1,000 beneficiaries) for any condition were 21% lower (405 vs. 513)," reported Martijn van Hasselt of the University of North Carolina at Greensboro and his associates. RTI International conducted the study. "Average Medicare payments per Medicare [fee-for-service] beneficiary, except for [federally qualified health center] payments were also lower for NCQA-recognized PCMHs. For example, average total Medicare payments were 25% lower than for the comparison group ($5,382 vs. $7,169)," the report continued:

Researchers also found that emergency department visits declined for practices with PCMH recognition, though other utilization outcomes, including hospitalizations, 30-day readmissions and annual visits were not affected by receipt of recognition.

"Our findings suggest that the practices recognized as PCMHs were able to prevent some emergency department visits, perhaps through more efficient care coordination and care management," the authors stated. No financial disclosures were made by the study’s authors.

Findings of PCMH’s potential contradict results from a 3-year pilot study detailed in the Feb. 26 issue of JAMA, which showed that small- and medium-size primary care practices that had created PCMHs were not successful in reducing costs or curbing hospital and emergency department visits (JAMA 2014;311:815-25 [doi:10.1001/jama.2014.353]).

gtwachtman@frontlinemedcom.com