Patient-centered medical homes lower costs, reduce healthcare overuse

The evidence is clear that the use of patient-centered medical homes (PCMHs) can reduce healthcare costs, overuse of the emergency department and overall inpatient hospitalizations, according to a new, comprehensive report from the Patient-Centered Primary Care Collaborative (PCPCC).

The findings, which evaluated scholarly publications, state government reports and industry reports for a total of 28 publications, expand upon the existing data that support the improvements in cost and utilization associated with medical homes, the report states. PCPCC defines the PCMH as "a model for achieving primary care excellence so that care is received in the right place, at the right time and in the manner that best suits a patient's needs," according to the organization's website.

In the scholarly publications the PCPCC report reviewed, six of the 10 found the use of PCMHs reduced healthcare costs, and 12 out of 13 reported "improvements in utilization," such as reduced ED visits and inpatient hospitalizations. Meanwhile, all seven state government reports indicated cost reductions and 86 percent found utilization improvements. Finally, 57 percent of industry reports found savings and 86 percent of them reported improvements in utilization.

"If you are interested in cost savings and institutional improvements, you can find them with patient-centered medical homes," PCPCC CEO Marci Nielsen told FierceHealthcare in an exclusive interview. "When you really are investing in primary care, you can drive down utilization in other areas of your organization that are high-cost."

Though not the main focus of the report, some of the studies reviewed by PCPCC also found statistically significant improvements in quality of care metrics, such as access to care and patient satisfaction, that were associated with PCMHs, the report states.

"The evaluations of the PCMH described in the report underscore the growing evidence base that ties the medical home model of care to reductions in health care costs and improvements in quality," Christopher Koller, president of the Milbank Memorial Fund, which funded the report, said in a statement. "However, in order for the PCMH to be sustainable, we need greater investment in primary care and less reliance on the fee-for-service payment system."

To that end, PCPCC was pleased to hear this week's announcement that the Department of Health and Human Services plans to tie half of provider payments to care-quality measures in the space of five years.

"It's a great week for value-based purchasing, and for alternative payment models," Nielsen said. "And the data in our report underscore what the major purchasers are seeing in their own backyards."

Based on the advice of various experts, the PCPCC report makes the following recommendations for how to expand upon medical homes' cost and quality improvements in healthcare:

  • Integrate services both inside and outside primary care practices, such as combining PCMHs with accountable care organizations
  • Fund enhanced primary care that helps control costs while maintaining or improving quality for patients
  • Engage patients and the public in PCMH transformation and quality improvement measures
  • Train primary care professionals to embrace a team-based approach to medicine that treats patients and their family or caregivers as partners in their care
  • Develop technology to support the PCMH model of care

Though the PCMH model has had to overcome many obstacles in its goal to achieve the Triple Aim of better care, improved population health and lower costs, the PCPCC report is not the first study to conclude that the model has produced promising results, FiercePracticeManagement has reported.

"The bottom line is the news is positive but we've got more work to do," Nielsen said.

To learn more:
- here's the report
- read the statement