New Report Outlines Success of PCMH Model in Variety of Public, Private Demonstrations

September 07, 2012 04:55 pm James Arvantes

As more public and private entities adopt the patient-centered medical home (PCMH) model, the concept is "evolving to better connect and coordinate with the medical neighborhood, including accountable care organizations and other integrated systems of care," according to a new report released by the Patient-Centered Primary Care Collaborative (PCPCC).

"The number of medical home providers has grown to the tens of thousands, serving millions of Americans," says Benefits of Implementing the Primary Care Patient-Centered Medical Home: A Review of Cost and Quality Results, 2012. "Momentum for the model is rapidly increasing with public and private sector investment," which is propelling health care to a "tipping point" for the delivery of patient-centered care in the United States.

"The evidence is clear, convincing and compelling when you look to both industry reports, as well as the academic literature, that we have really come to a model that offers better care, better quality and lower costs," said Marci Nielsen, M.P.H., Ph.D., executive director of the PCPCC, during a press briefing announcing the release of the report.

The report serves as a follow-up to a study released by the PCPCC in 2010 and provides a summary of new and updated results from PCMH initiatives during the past two years, including cost and quality outcomes data.

For example, according to the report, the U.S. Air Force experienced 14 percent fewer emergency department and urgent care visits between 2009 and 2011 as a result of a PCMH initiative. One Air Force base in Utah saved $300,000 annually between 2009 and 2011 thanks to improved diabetes care management that resulted from a PCMH program.

story highlights

  • The patient-centered medical home (PCMH) model is a catalyst for health care reform efforts that repeatedly demonstrates improved quality, enhanced access and cost savings, according to a new report from the Patient-Centered Primary Care Collaborative.
  • The report documents PCMH initiatives in both the public and private sectors, demonstrating widespread adoption of the PCMH, as well as the model's effectiveness.
  • The report provides numerous examples of PCMH programs that contribute to better health, improved care and/or lower cost within participating practices.

Other initiatives have achieved similar results, according to the report. CareFirst, a private insurance carrier in the mid-Atlantic region, launched a PCMH program in early 2011 in the Washington metropolitan area and achieved nearly $40 million in savings in 201l. The program also saw a 4.2 percent reduction in expected patient overall health care costs among 60 percent of practices that participated in the program for six months or more.

In Florida, a PCMH program launched by the Capital Health Plan of Tallahassee saw 40 percent fewer inpatient hospital days, 37 percent fewer emergency department visits and an 18 percent reduction in health care claims costs from 2003 through 2011. In addition, participating practices saw a 250 percent increase in primary care visits, according to the report.

These results "provide substantial empirical support for the PCMH and the health care professionals, health plans, employers and policymakers who are adopting it, as well as the patients and their families receiving this care," says the report.

"Growing support for the PCMH has arisen across the vast majority of the U.S. health care delivery system to include more than 90 commercial insurance plans, multiple employers, 42 state Medicaid programs, numerous federal agencies, the Department of Defense, hundreds of safety net clinics, and thousands of small and large clinical practices nationwide," says the PCPCC report.

"Major health plans and industry partners are embracing the PCMH model with enthusiasm by creating insurance plans and developing tools and resources contributing to the implementation of medical homes."

Major insurance carriers that have adopted PCMH initiatives include WellPoint, Aetna, Humana, UnitedHealthcare and various Blue Cross and Blue Shield plans, says the report, adding, "WellPoint predicts that its new PCMH program could reduce its projected medical costs in 2015 by up to 20 percent based on analysis of its current medical home pilot projects. UnitedHealthcare estimates that its new efforts will save twice as much as they cost."

The conclusions the report's authors draw are that

  • the increasing use of the PCMH model is helping to achieve better health, better care and lower costs in the U.S. health care system;
  • PCMH expansion has reached a "tipping point" in the United States and is experiencing broad public and private support;
  • investing in the PCMH model results in short-term and long-term savings for patients, their employers, health plans and policymakers; and
  • using the PCMH model to partner with patients and their families could help achieve and sustain transformational change in primary care, as well as in the continuum of care.