The promise of Patient-Centered Medical Homes (PCMH) has been that the improved emphasis on prevention, patient engagement, and care coordination would lead to better overall health and…..wait for it….lower cost of care.  And we have been waiting for proof of the theory.  Even as early indications showed lower Emergency Department use and reduced hospitalization, the correlation to lower cost was difficult to compute.  Now, with more pilot projects under review, the evidence is starting to grow that cost reduction is an achievable goal.

In the attached article cites studies in 11 states showing PCMH either reduced utilization or  lowered cost.  The Blue Cross Blue Shield of Michigan Physician Group Incentive Program reported that practices with full PCMH implementation had savings of $26.37 per patient per month.  Another study in Colorado had one payor demonstrating return on investment ranging from 2.5:1 to 4.5:1 for every dollar spent on the pilot.

Promising news as we prepare to analyse pilot results here in the Greater Cincinnati Region.

John Commins, for HealthLeaders Media , January 15, 2014

Data collected from 11 states strongly suggests that the question to ask about the patient-centered medical home model is not whether it reduces healthcare costs and improves outcomes, but how well.

Forgive me for preaching to the choir, but another round-up of studies released this week re-confirms what we already know: Patient-centered medical homes improve health outcomes and reduce costs.

In fact, the question is no longer “will they work?” Evidence increasingly settles that question. Now the questions center around just how effective PCMHs can be in reducing costs and improving outcomes.

Consider the findings in an analysis released this week from the Patient-Centered Primary Care Collaborative. It’s a composite of peer-review and industry-generated studies, showing that the PCMH model is reducing costs of care, unnecessary emergency department and hospital visits, and increasing the use of preventive services and improving population health.

These findings are more than regional success stories. The study includes data from 20 PCMH projects in 11 states from New Hampshire to Alaska, and national data from PCMHs serving active-military and veterans, which show that 60% of the PCMH evaluations reported decreases in cost of care or use of unnecessary services, while 30% saw improved population health.

Diabetes Care Results
The Colorado Multi-Payer PCMH Pilot Model that focused on diabetic care posted particularly impressive result over three years, which included:

  • A 15% reduction in ED visits, compared with 4% for a control group;
  • 18% fewer inpatient admissions compared to an 18% increase for the control group;
  • No increase in specialty referrals compared with 10% increase for the control group; and
  • A return on investment ranging from 2.5:1 to 4.5:1 for every dollar spent by WellPoint on the pilot.

In addition, 95% of the patients said the care was efficient and well organized and 97% said they would recommend the program to family and friends.

The Blue Cross Blue Shield of Michigan Physician Group Incentive Program reported that practices with full PCMH implementation had savings of $26.37 per patient per month and a 5.1% higher prevention composite score than colleagues in traditional practice settings.

While not every PCMH pilot can claim these levels of success, virtually every pilot examined by the Collaborative demonstrated improvements over the traditional fee-for-service practice model that provides incremental, episodic care and incentivizes volume.

No Easy Path to PCMH
These measureable results reflect the remarkably simple concept behind PCMH, which is to proactively manage patient chronic care to reduce expensive episodic care. The results are healthier, engaged patients and reduced costs.

We are hearing from any number of providers across the nation, however, that the actually journey to become a PCMH is not easy. The process is rife with snafus with electronic medical records, interoperability roadblocks, reimbursement challenges, and grueling federal mandates and timelines.

It’s important to remember that these PCMHs are largely pilot projects that are providing the first rough drafts of how a value-based care model will work. The PCMH is still a work in progress, but it’s already demonstrated that it can reduce the cost of care, reduce ER visits and inpatient admissions, improving population health, access to care and patient satisfaction. Even with the rough spots, that seems like a reasonable trade-off.

There is nothing to suggest that any start-up woes in the PCMH model are permanent. In fact, it seems reasonable to presume that PCMHs will continue to improve care and efficiencies while reducing costs as they gain more experience and refine the model.

Early Finding Stand Up to Scrutiny
Clearly, the Collaborative has a bias here in placing PCMHs in the best possible light. But I don’t think they’re cooking the data and I would be happy to speak with any skeptics who can show me that the PCMH model doesn’t work. Of course, skeptics should be prepared to provide their blueprint for “bending the cost curve” in healthcare.

Obviously, I am an unabashed fan of the PCMH. The returns may be preliminary, but the trends are inarguable. It is gratifying to see that a complex but innovative care model which makes so much sense is delivering on its potential for improving care while reducing costs. Even better, we should fully expect that these results will improve in the coming years.

For now, the composite results gathered by the Collaborative are very impressive. PCMH advocates shouldn’t be afraid to crow about the findings. As Walt Whitman once wrote: “If you done it, it ain’t bragging.”