Medicaid can reap the rewards of medical homes

Medicaid programs could lower costs and boost quality care by implementing a patient-centered medical home model. Connecticut, for example, incorporated a medical home for its Medicaid program, improving quality and dropping per-member costs by 2 percent in only 18 months.

Additionally, children who went to Medicaid medical home practices were more than 10 percent more likely to receive recommended early and periodic screening, diagnostic and treatment screenings. And the quality of care provided to Medicaid members by medical homes in Connecticut exceeded the quality of care from nonmedical home practices, the Hartford Courant reported.

"Our experts note that the patient-centered medical home approach has had a demonstrable effect on health outcomes and member satisfaction," David Dearborn, spokesman for Connecticut's department of social services, told the Courant.

For more proof of medical homes successfully lowering costs and improving quality, look to CareFirst Blue Cross Blue Shield. Over three years, CareFirst members participating in its medical home program have 6.4 percent fewer hospital admissions, 11 percent fewer days in the hospital and 8 percent fewer hospital readmissions, according to a statement from the Maryland-based insurer.

CareFirst saved $267 million with its medical home, which rewards primary care doctors with incentives of up to $30,000. "This has been well received by the members in it, as well as the physicians in it," CareFirst CEO Chet Burrell told the Baltimore Business Journal.

However, those improvements won't come without challenges. One issue facing the Medicaid medical home is the need to certify the provider practices since obtaining certification from the National Committee for Quality Assurance can be costly and administratively burdensome, the Courant noted. Moreover, some doctor offices are slow to embrace medical homes because of the high cost of buying computer equipment and software that's needed to operate electronic medical records.

These concerns are in line with worries cited in a study from health information network Availity, which found that although 75 percent of providers participate in at least one value-based payment model, less than 30 percent say the reward justifies the risk taken.

To learn more:
- read the Hartford Courant article
- check out the Baltimore Business Journal article
- see the CareFirst statement