Making the Evidenced-Based Case for the PCMH

The Medicare Payment Advisory Commission (MedPAC) recently aired concerns as to whether the patient-centered medical home (PCMH) can serve as a model for providing value-based care. In particular, several members asserted that the medical home model may have a “real cost disadvantage” for health systems. They explained that without evidence-based research, it is difficult to determine if the model encourages practices to use their cost savings to improve care.

“It's going to organizations that employ physicians, and they’re going to use that money however they see fit,” said Jon Christianson, PhD, from the School of Public Health at the University of Minnesota in Minneapolis, and MedPAC Commission member. “That may be putting it into specialty care.”

One study, examining the Chronic Care Initiative in Pennsylvania, supports MedPAC’s notions. The study looked at 32 practices participating in the Southeastern Pennsylvania Chronic Care Initiative, between June 2008 and May 2011. The pilot program financed physician practices in order to help them become certified as PCMHs by the National Committee for Quality Assurance (NCQA); 3 private insurers and 3 Medicaid managed care plans participated.

Researchers concluded that the PCMH demonstration project did little to reduce costs and utilization, or to improve patients’ quality of care over a 3-year period. They added that, “These findings suggest that medical home interventions may need further refinement.”

Conversely, a more recent study published in The American Journal of Managed Care (AJMC), found different results when examining practices from the same Pennsylvania initiative. Researchers in this study focused on 700 Independence Blue Cross members with multiple chronic conditions. Costs and utilization for the highest risk group of patients was significantly reduced using the PCMH model when compared with patients treated at a regular practice.

The difference in these findings means that more evidence is needed to determine which patients would benefit the most from care in a PCMH. Adequate conclusions simply cannot be made based on 1 or 2 studies.

“As research continues, we will hopefully be able to more specifically refine our focus of what works in the PCMH and discover in which patients, in which practices, and with which type of interventions we will be able to make a difference,” said Fred Pelzman, MD, associate medical director of Weill Cornell Internal Medicine Associates.

Thomas Schwenk, MD, dean of the University of Nevada School of Medicine in Reno, echoed Dr Pelzman’s sentiments. “It is time to replace enthusiasm and promotion with scientific rigor and prudence, and to better understand what the PCMH is and is not. Widespread implementation of the PCMH with limited data may lead to failure,” he said.

More information about the AJMC study is available here.

Around the Web

Medical Homes May Not Be the Answer [MedPage Today]

One PCMH Pilot, Two Different Results [MedPage Today]