Marci Nielsen, Ph.D., M.P.H., CEO of the Patient-Centered Primary Care Collaborative, discusses the performance of medical homes during an event on Capitol Hill.
An annual report on patient-centered medical homes (PCMHs) shows the model is contributing to reduced costs and improved patient care on multiple fronts.
The Patient-Centered Primary Care Collaborative's annual report(www.pcpcc.org) on the impact the PCMH model has on cost and quality of care aggregates 30 studies that were published in various outlets. The collaborative recently hosted a discussion on Capitol Hill about the report and the future prospects for medical homes. Reps. David Rouzer, R-N.C., and Joe Courtney, D-Conn., co-founders of the Congressional Primary Care Caucus, attended the event and gave brief remarks in support of primary care and practice transformation.
What PCMH initiatives share in common, according to the report, is steady progress on reducing costs and the volume of expensive procedures. Among 23 studies that measured changes in cost, 21 reported reductions in one or more categories. Likewise, among 25 studies that evaluated hospital utilization rates, 23 reported reductions in one or more categories.
- A recent report shows that the patient-centered medical home (PCMH) model is making steady improvement on costs and patient care.
- Primary care practices are crucial to the success of medical homes but the report notes they have not received adequate support.
- Making the PCMH model work requires offering the right incentives along with appropriate support for transformation efforts.
But the report highlights the need for better support of the primary care practices that are crucial to the success of the PCMH model. Fifty-five percent of physician office visits each year are for primary care, yet primary care received only 4 percent to 7 percent of the $2.9 trillion that Americans spent on health care in 2013.
"We believe that the 4 percent investment in primary care should at least be doubled," said Marci Nielsen, Ph.D., M.P.H., CEO of the Patient-Centered Primary Care Collaborative.
Christopher Koller, president of the Milbank Memorial Fund and a former Rhode Island health insurance commissioner, said insurance executives are aware of the need for more emphasis on primary care.
"The chief medical officers (of insurers) know the value of primary care," Koller said. "But they cannot move first because of competitive advantage. We have to find ways to put primary care first."
The cost savings of successful transformation can be considerable. Under the PCMH model, the University of California, Los Angles, Health System showed a 20 percent reduction in emergency visits and a $1 million reduction in the total cost of care compared to control practices. Among physicians in the system who participated in a survey, 94 percent said the program was effective.
A Blue Cross initiative in New Jersey reported a 9 percent reduction in total cost of care, an 8 percent reduction in hospital admissions and a 5 percent decline in emergency visits.
The report makes clear that missing from the available data, however, is research on health outcomes, the patient experience and physician satisfaction, all elements of the shift to new payment models.
Reps. David Rouzer, (left) R-N.C., and Joe Courtney, D-Conn., co-founders of the Primary Care Caucus, speak during a press event on Capitol Hill that addressed the performance of medical homes.
Those new payment models are important, because fee-for-service does not compensate physicians for key PCMH features such as information sharing, care coordination or phone conversations with patients. Moving to the PCMH model can be especially difficult for smaller practices absent such compensation.
"This work is hard. This work is expensive. This work is slow," Nielsen said.
Making the PCMH model work requires offering the right incentives along with appropriate support for transformation efforts. But initially, insurers attempted to support practice changes simply by offering a monthly per member payment that was "as low as possible," according to Len Nichols, Ph.D., a professor of health policy at George Mason University in Fairfax, Va. He said the low payments did not work because they did not offset the cost of hiring new staff.
And other incentives that could have bolstered reform failed to take hold. For instance, Nichols said, CMS had a "unique opportunity" to support accountable care organizations by offering an incentive for patients to stay with one for a year in the form of reduced Part B premiums. Political opposition killed the measure, but he said the concept is still a "good idea" that Medicare might embrace if private insurers take the lead.
"After private plans do it, Medicare will have the incentive to do it," Nichols said.
Ironically, while HHS is pushing for alternative payment models and new delivery systems to take hold in the next two years, the report notes that Medicare is not considered a leader in supporting PCMH initiatives.
"While states and commercial payers have for many years piloted various forms of payment alignment to support primary care and the PCMH, the Medicare program has been slower to adopt and scale similar care delivery and payment reforms," the authors wrote.
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