Patient-centered medical homes deliver on care coordination but not all metrics

By Aine Cryts

While patient-centered medical homes (PCMHs) fare well with care coordination, they're falling short on providing first contact, continuity and comprehensive care, according to a recent Health Affairs blog post.

Researchers conducted 32 interviews with individuals at primary care practices or those who have leadership roles in accountable care organizations (ACOs) and insurance companies as part of a study that examined the interaction of advanced primary care practices and ACOs.

Here's how PCMHs are faring on the other three Cs, according to blog post authors Robert Berenson, M.D., an institute fellow at the Urban Institute, and Rachel Burton, a senior research associate in the Urban Institute's Health Policy Center:

PCMHs don't deliver on first contact and continuity of care. A mere 29 percent of practices provide after-hours care for patients beyond automated phone referral to emergency rooms (ER), according to the blog post. Despite proof that access to a primary care physician after hours can improve patient outcomes and reduce ER use, only 30 percent of patients reported that it was very or somewhat easy to access care on nights or weekends, write Berenson and Burton.

Hospitalists and patients' primary care physicians don't work together--and that translates into avoidable ER admissions. Part of the problem is PCMHs aren't assessed on primary care physicians' involvement in their patients' hospital care, even though their lack of involvement can mean higher long-term costs and poor outcomes, according to the authors.

PCMHs don't provide comprehensive care. Delivering comprehensive care is related to lower healthcare spending, but fewer primary care physicians care for the full spectrum of patients' physical and mental healthcare needs. Proof of this: Physician referrals have skyrocketed from 41 million to 105 million each year--and that's a 159 percent increase in 10 years, according to the blog post.

Tools that assess PCMHs don't account for the role of physicians in providing comprehensive care--and instead focus on the multidisciplinary team approach that includes care coordinators, part-time pharmacists and health educators, they write.

To learn more:
- read the blog post

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