Dozens of articles each year evaluate progress of the patient-centered medical home (PCMH), but a new report takes a broader view to examine how elements of the model in both medical home and nonmedical home practices affect cost, quality and utilization.
Ann Greiner, president and CEO of the Patient-Centered Primary Care Collaborative, talks about the implications of the group's new annual report at a recent panel discussion.
Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care undertook this more expansive examination for the annual report(www.pcpcc.org) of the Patient-Centered Primary Care Collaborative(www.pcpcc.org) (PCPCC). This year's report, titled The Impact of Primary Care Practice Transformation on Cost, Quality and Utilization, seeks "to capture any evidence relevant to 'high-performing' primary care, not merely the PCMH,'" the authors noted.
The researchers reviewed 45 articles published in 2016 for the report, which was released in tandem with a July 10 event and panel discussion. Seventeen of these studies compared medical home implementation to traditional care, 15 focused on features that are included in medical home care delivery, and 13 examined initiatives that enhanced the medical home model.
Studies that included an analysis of costs generally found either small savings or no change. Eight reported lower costs, three reported higher costs and two reported mixed results.
- Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care undertook an expansive examination of elements of the patient-centered medical home model for the Patient-Centered Primary Care Collaborative's annual report.
- In general, the report found decreased costs and better results in more mature initiatives and for patients with more complex conditions.
- About 45 percent of family physicians now practice in a medical home, and 44 states and the District of Columbia have laws that define or demonstrate the model.
Most of the studies that measured ER visits reported positive results -- six finding reduced ER utilization, three with mixed results and one finding increased utilization. For quality of care, 11 reported positive results, 11 reported mixed results and two showed negative results.
In addition, two studies examined efforts to reduce physician burnout, with encouraging results in practices that promote a strong culture of teamwork.
In general, the annual report found decreased costs and better results in more mature initiatives and for patients with more complex conditions.
Many of the studies the authors reviewed examined practices that had only one or two years of experience in the medical home model, the authors noted, and gradual changes to the model have demonstrated improvement in the patient experience.
"It is quite clear that team-based interventions, including case management and having a usual source of care, have positively impacted the patient experience," the report stated. "That said, there is no single 'implementation manual' that meets the needs of all."
About 45 percent of family physicians now practice within a medical home, and 44 states and the District of Columbia have laws that define or demonstrate the model.
Chris Kohler, president of the Milbank Memorial Fund, spoke during the launch event and noted that this year's annual report takes a more critical look at medical home performance than previous editions did, making a strong case for the critical role that primary care plays in the success of the model.
"The evidence shows that a high-performing health care system has to have primary care at its core," Kohler said. "But in the U.S., we don't follow that evidence."
Kohler praised the Center for Medicare and Medicaid Innovation for its efforts to try different incentive-based payment models and for putting an emphasis on patient-focused care. He said the center should receive continued support.
"Are they hitting the bull's-eye every time? No," he said. "Are they making health care delivery better? Yes."
The report looks closely at Blue Cross Blue Shield of Michigan, now in its eighth year. It manages one of the largest and oldest medical home initiatives in the United States, with 4,534 primary care physicians in 1,638 practices. The initiative reduced adult ER visits by 15 percent, ambulatory care inpatient stays by 21 percent and monthly per-patient costs by $26. In addition, screenings for breast, cervical and colorectal cancer increased, as did quality of care and use of preventive services overall.
One family physician who participates in the Michigan initiative discussed how it allowed both him and his patients to be more engaged in care.
"I've never been more energized than I am now," said Gregg Stefanek, D.O., of Gratiot Family Practice in Alma, Mich.
Stefanek welcomes questions and input about care from his patients because by adopting more of the role of a guide, he encourages patients to take more responsibility for their own care.
"My visits are better when the patients are prepared," he said.
Stefanek also discussed how using a scribe to take notes during patient consultations has helped him a great deal. The scribe handles immunizations, wellness visits, and A1c and cholesterol screenings. After working with Stefanek for years, the scribe can guide the patient visit. In addition, working in an alternative payment model has allowed his practice to hire staff to help with administration and pre-visit planning.
"I don't care if my patients can tell me what a patient-centered medical home is," Stefanek said. "I want them to be able to know what it is like to be well cared for."
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