PCMH programs cut costs and improve quality. Collaboration is the key to their success

WASHINGTON, D.C.—Reviews of patient-centered medical homes suggest that they lead to lower costs and improved care quality, but a significant investment in primary care and strong payer-provider collaboration is key to success.

The Patient-Centered Primary Care Collective (PCPCC) released its sixth report on PCMHs Monday, and researchers at the Robert Graham Center found overall positive results in cost reduction, quality improvement and utilization, but not uniformly. The team reviewed 46 peer-reviewed studies and some grey literature as well to determine the state of PCMH programs across the country.

There is bipartisan support for improving primary care, said Ann Greiner, president and CEO of PCPCC, at a briefing to mark the report’s release, but there is more work to be done.

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The review found the most positive results involved cost reduction. Eight studies showed positive results, two reported mixed results and three found negative results. Quality and inpatient utilization reports were more mixed overall; for quality, 11 studies reported positive results with the same number reporting mixed results. Inpatient utilization was also equal, with three reporting positive results and three indicating mixed results.

Some of this variation could be reflected in the study trying to fit a square peg into a round hole, as the programs vary across regions, said researcher Yalda Jabbarpour, M.D., a professor of family medicine at Georgetown University. Some states individually saw improvements that were not reflected in nationwide trends, she said.

“When you’ve seen one patient-centered medical home .. .you’ve seen one patient-centered medical home,” Jabbarpour said.

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One PCMH has found particular success in Michigan, an eight-year effort headed by local physician organizations and Blue Cross Blue Shield of Michigan. BCBS’ patient-centered experience is one of the largest and oldest in the country, and includes more than 4,500 primary care doctors at more than 1,600 practices.

There were several keys to success for BCBS, according to the report. A number of different stakeholders had to be brought to the table and energized around the program. Program leaders encouraged an incremental approach that rewarded physicians’ efforts and galvanized multipayer support through the five-year Michigan Multi-Payer Advanced Primary Care Practice Demonstration Program.

PCMH programs encourage patients to be more empowered, and foster camaraderie between payers and providers, said Gregg Stefanek, D.O., a family practice doctor with Covenant Healthcare who works within Michigan’s PCMH. The format generates dialogue between two groups that are often at odds, said Christopher Koller, president of the Milbank Memorial Fund, which backed the study.

“We’re using the carrot and also using the stick a little bit,” Stefanek said.

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Koller offered several ways that federal lawmakers can continue to support advanced primary care programs, including:

  • Continue the work of the Centers for Medicare & Medicaid Innovation: Providers and commercial payers follow Medicare’s lead, Koller said, and while not every experiment from CMMI has been perfect, its efforts are truly driving the transition from volume to value.
  • High-quality primary care should be a key part of insurance benefits. “It’s cheap, and it works,” Koller said, as primary care can cut costs and reduce hospital overuse.
  • Make primary care attractive to medical students. There is a dearth of new doctors going into family medicine because many medical students prefer the higher salary and prestige that comes with being a specialist. Medicare can support increased emphasis on primary care education to make the work attractive, Koller said.