Shared savings: The key to patient-centered medical home success?

Patient-centered medical homes (PCMHs) may have the most success in their mission to improve care quality and lower healthcare utilization when they offer financial incentives for participants in the form of shared savings, a new study suggests.

The three-year study, led by the RAND Corporation and published in JAMA Internal Medicine, examined claims data from the northeast region of the Pennsylvania Chronic Care Initiative, a "medical home intervention" comprising two commercial health plans and 27 primary care practices.

When researchers measured the medical home participants' performance on six quality measures against that of 29 comparison practices, they found that the latter produced better outcomes. The medical home practices boasted better performance on four process measures of diabetes care and cancer screening, lower rates of emergency department (ED) visits and hospitalizations, lower rates of ambulatory visits to specialists and higher rates of primary care visits.

Researchers evaluated the same Pennsylvania program in a study published in 2014, and in that case found that the PCMH model failed to lower costs, lower healthcare utilization or improve quality.

There may be several reasons why the two studies' results differ, the study authors write, including the use of a "substantial shared-savings initiative," regular feedback from health plans to providers on hospital and ED use, and baseline electronic health record use. The practices featured in the most recent study also achieved medical home recognition under updated criteria, suggesting they may have better care management capabilities, the authors write.

Perhaps most compelling, though, is the fact that financial incentives may boost PCMHs' performance, Mark W. Friedberg, M.D., the lead study author, said in an announcement. "These findings suggest that by directly motivating and supporting efforts by primary care practices to manage a patient's journey throughout the healthcare system, medical home interventions can reduce the use of hospital and emergency care," he said.

The most recent study also "underscores recent achievements in payment reform," such as the Medicare Access and CHIP Reauthorization Act, which includes incentives for PCMH adoption and will help realize the Department of Health and Human Services' goal to speed up the transition to alternative payment models, according to a statement from the Patient-Centered Primary Care Collaborative (PCPCC).

The PCPCC issued its own report in late January that analyzed scholarly publications, state government reports and industry reports' data on PCMH performance, and found that many helped reduce costs and hospital and ED use, FierceHealthcare has reported.

To learn more:
- here's the study abstract
- read the announcement
- check out the PCPCC statement