Patient-centered medical homes a 'work in progress'

The patient-centered medical home may not be as effective in improving quality care and lowering costs as hoped, according to a new study published in the Journal of the American Medical Association.

The study, conducted by researchers at the RAND Corporation and funded by Commonwealth Fund and Aetna Inc., evaluated the Southeastern Pennsylvania Chronic Care Initiative, one of the United States' earliest and largest medical home pilots. The pilot resulted in limited quality improvement and failed to save money over a three-year period, according to Mark W. Friedberg, M.D., a RAND researcher and the study's lead author.

These results don't necessarily mean the model doesn't work, he added, but that cost savings and quality improvement goals are a challenge to execute. "Expectations for medical homes are really high," Friedberg told the New York Times. "Right now, it's a work in progress."

The JAMA study involved 32 Pennsylvania medical homes, comparing them with traditional primary care practices. Between 2008 to 2011, medical homes achieved slight improvement in one of 11 quality metrics, according to researchers, and didn't save on costs. Rather, the medical homes earned $92,000 in bonuses per physician during the three-year period, Bloomberg Businessweek reported.

"I wouldn't consider this a failure, I consider it a very good learning experience," Marcela Diaz-Myers, director of the Pennsylvania Health Department's Center for Practice Transformation and Innovation, told Bloomberg. "We didn't do enough care management in the first three years, and have put more emphasis on it since then."

Practices could also expand night and weekend hours to reduce the number of highly complex, chronically ill patients using emergency rooms, according to the Times. More than half the pilot practices offered extended hours before the study began, Friedberg said, but the number of practices doing so did not increase much during the study period.

To learn more:
- here's the abstract from JAMA
- read the Times article 
- see the Bloomberg story