Tuesday Feb 16, 2016
Report: PCMH improves quality, reduces cost
"We've been together since way back when,
And sometimes I never want to see you again.
But I want you to know, after all these years,
That you're still the one …"
Nine years ago this month, the American Academy of Family Physicians collaborated with the American College of Physicians, American Academy of Pediatrics, and the American Osteopathic Association to develop and introduce the Joint Principles of the Patient-Centered Medical Home (PCMH). These principles were viewed as the articulation of ideas that would establish a health care system that was focused on the patient, foundational in primary care, and mindful of appropriate use of our limited health care resources.
Since February 2007, the Joint Principles have been foundational in establishing a variety of advanced primary care delivery models in public and private health care systems and remain the most applicable and appropriate roadmap for primary care delivery system reforms. Today, the PCMH, or some variation of the concept, is recognized by every major private insurer, Medicare, Medicaid, the Veterans Health Administration, and the Department of Defense. And, most importantly, it is the only delivery system model mentioned and recognized in the recently enacted and soon to be implemented Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
So after nine years, the question we all should be asking ourselves is: "Do advanced primary care practices built on the principles of the PCMH improve quality and reduce the cost of health care?"
For the answer, I point you to a report recently released by the Patient-Centered Primary Care Collaborative (PCPCC) entitled the "Patient-Centered Medical Home's Impact on Cost & Quality: Annual Review of Evidence 2014-2015(www.pcpcc.org)." The PCPCC report looked at 30 published studies of advanced primary care or medical home practices and or programs. Seventeen of these studies were peer-reviewed, four were state government evaluations, six were industry reports, and three were independent evaluations of federal initiatives. Based on this report, I would suggest that the answer to the question above is yes, but let's take a look at the key findings from the report's executive summary:
- This year's 30 publications point to a clear trend showing that the medical home drives reductions in health care costs and/or unnecessary utilization, such as emergency department visits, inpatient hospitalizations and hospital readmissions.
- Those with the most impressive cost and utilization outcomes were generally those who participated in multipayer collaboratives with specific incentives or performance measures linked to quality, utilization, patient engagement or cost savings.
- The more mature medical home programs demonstrated stronger improvements.
Each of you has a rich understanding of just how impactful comprehensive, continuous, and connected primary care can be. You live it each day. This report and others that have been published during the past few years are starting to demonstrate, in a quantifiable manner, the true value of primary care.
I had three other important takeaways from the PCPCC report:
- The most glaring demonstration of the value among advanced primary care practices is the decrease in emergency room visits, especially emergency room visits for primary care services. The second is the decrease in hospital admissions. These utilization reductions were noted in the PCPCC report, but they were also key findings in the latest Comprehensive Primary Care Initiative report(innovation.cms.gov). It is really quite simple, hospitals and the care provided in hospitals are expensive and when we focus on reducing the frequency of patient visits in those settings we save money.
- Time and experience yield stronger outcomes in quality and cost. The PCPCC report clearly demonstrates that advanced primary care practices need time to develop and mature before they truly produce significant improvements in quality and cost. Think of it this way, PCMH's are like children or good scotch -- they need time and space to mature.
- Payment reform remains both essential and elusive. I was struck by the differences in outcomes among those programs that had made meaningful changes in the payment system for their participating advanced primary care practices versus those that didn't. Each category demonstrated improvement, but the presence of meaningful payment reforms certainly accelerated progress. We have much work to do in this space. Fifty-five percent of all medical office visits are to a primary care physician, yet only 4 percent to 7 percent of our total health care spend is directed to primary care. We can't continue to ask family medicine and primary care to shoulder the responsibility of health delivery system reform on what is essentially the scraps of our overall health care spend.
It has not been an easy ride, but the AAFP remains strongly supportive of the Joint Principles. They remain as needed and applicable today as they did when they were created. There is work to do, of course. However, there is growing evidence that advanced primary care practices, when supported by systemic changes in payments, improve quality and decrease the overall cost of health care. That's why, as the song lyric states, PCMH is "still the one."
Public Health Alert: Zika
Many of you have likely been following the Zika virus issue. The AAFP has as well. My colleagues in the AAFP's Division of Health of the Public and Science have been working diligently to assemble information and resources for you and your practice. I encourage you to use these excellent resources and share them with your colleagues. As a family physician you play an important role in public health outbreaks such as this and we urge you to be prepared to assist your patients and your community.
In addition to the AAFP's resources, you may find Zika related resources at the following sites:
Posted at 07:00AM Feb 16, 2016 by Shawn Martin