The seemingly simple idea of a patient-centered medical home (PCMH), which boils down to primary care physicians aggressively managing patient care for all stages of life and coordinating care with other health professionals, has been a long time coming.
If adopted widely over the next few years, proponents say it will replace disease management programs and reduce costs.
Already, the benefits of the PCMH approach are becoming apparent.
Blue Cross Blue Shield of Michigan began a few years ago to offer network physicians a 10 percent reimbursement hike if their practices qualified as a PCMH. Company officials say they have seen adult emergency room visits fall by 1.4 percent and a drop in chronic disease complications in patients treated by the 1,800 doctors in the program.
There has been a 2.0 percent reduction in radiology utilization, 2.2 percent fewer pediatric ER visits, and a 2.6 percent decrease in inpatient admissions. Overall patient care costs have dropped about 1.2 percent. With 2 million participating patients, these metrics have created significant savings, say plan officials.
A Pennsylvania PCMH pilot project echoes the Blue Cross Blue Shield of Michigan results. In a joint effort by state insurers and the Governor's Office of Health Care Reform, 32 practices were qualified as PCMHs. More than 200 providers serving more than 200,000 patients were tracked.
Among diabetes patients, there was a 33 percent improvement in blood sugar control, 71 percent more got eye exams, and 142 percent more had foot exams.
In fact, the only treatment area that experienced an increase was prescription drug costs, which rose 11 percent--a figure easily offset by a 26 percent drop in inpatient admissions. The bottom line was a monthly per-member per-month savings of $46.37.
The single biggest obstacle to widespread adoption of the PCMH concept is lack of familiarity among providers and payers, say researchers from the Center for Studying Health System Change.
Now that payers and providers can see how PCMHs can lead to cost savings, adoption should gain momentum. - Martin
Editor's note: Martin Sipkoff is a contributing editor with Managed Care magazine.