Last week JAMA published, “Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care.” The authors found that a large multi-payer patient-centered medical home (PCMH) program in northeast Pennsylvania (the Pennsylvania Chronic Care Initiative) achieved substantial reductions in unnecessary health care services, while improving the quality of care for its patients.
During the three-year study that began in October 2009, PCMH practices performed better than non-PCMH comparison practices in all four examined measures of diabetes care, as well as breast cancer screening. Additionally, PCMH practices had impressive increases in the rate of primary care visits, while emergency room use, patient hospitalization, and specialty care rates were substantially lower.
The authors, RAND researcher Dr. Mark Friedberg and colleagues, suggested that program success was due to:
- Payment Incentives – shared savings incentives for PCMH providers allowed practices to receive bonuses if total spending on patients was less than expected for the year;
- Timely Data – regular feedback from participating health plans enabled practices to continuously modify their efforts to meet benchmarks;
- Practice Transformation Focus – because financial incentives were not tied to early achievement of medical home recognition, practices were able to focus more on process improvement and learning collaborative activities;
- Electronic Health Record Adoption – all practices had electronic health records; and
- Advanced Primary Care – the practices were NCQA recognized, and were better positioned to implement case management and other advanced standards of care.
What makes this current study particularly interesting is that the same authors published an article in JAMA in late Feburary 2014 evaluating the same program. The 2014 study determined that the PCMH model was unsuccessful in improving the quality of care while reducing cost and utilization of services. This article generated much skepticism in the medical community.
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