New Review Evaluates Potential of Medical Home as Effective Primary Care Model

WASHINGTON, DC—February 29, 2012—A new systematic review of evidence conducted by Mathematica Policy Research in collaboration with the Agency for Healthcare Research and Quality (AHRQ) and published in The American Journal of Managed Care reveals that the patient-centered medical home (PCMH) model has the potential to improve quality of care, hospital care, and patient experience within the healthcare system. The review was conducted to help inform healthcare reform policy and program efforts across the nation and to offer guidance in how to better structure future evaluations.

A concept first introduced in the 1960s and recently reinvigorated in the wake of efforts to overhaul the healthcare system through innovations in primary care, the PCMH model is designed to transform the organization and delivery of primary care. The model intends to provide comprehensive, patient-centered, and more accessible care by placing significant emphasis on coordinating primary, specialty, and acute care and improving the quality and safety of healthcare services. To date, most evaluations of this approach have tested a precursor model, in which case managers were embedded, as opposed to testing the current PCMH model, which incorporates a fundamentally transformed primary practice. The Mathematica review is the first to both factor in the rigor of the evaluations and focus on multi-component interventions that most closely resemble the PCMH model being implemented today.

The review indicates that although the majority of evidence on PCMH precursors is inconclusive because of inadequacies in evaluation design or analytic methods, there is some favorable evidence on quality of care, hospital use, and patient experience among the older, sicker patients served by these precursors:

• Two of three rigorous evaluations of health outcomes found improvements

• Three of five rigorous evaluations of hospital use found that it was reduced for high-risk patients among the generally older, sicker patients served by these precursors

• Two of three rigorous evaluations of patient experience found improvements

The evidence, however, does not demonstrate clear cost savings as a result of changes implemented through these PCMH precursors. Only one intervention reduced costs, and that was limited to its high-risk patients among the low-income Medicare beneficiaries it served in the year after the intervention ended.

Overall, given that most evidence is inconclusive and based on PCMH precursors, there is a critical need for more rigorous evaluations of the current model. Mathematica has partnered with AHRQ to develop two additional resources to assist in efforts to improve the evidence base on medical homes: “Improving Evaluations for the Medical Home,” and “Building the Evidence Base of the Medical Home: What Sample and Sample Size Do Studies Need?”

Deborah Peikes, a senior researcher at Mathematica, said, “We know primary care matters. The PCMH is a promising approach to improving healthcare in the United States, but the model currently being implemented needs to be tested and refined to ensure that the efforts of providers and payers to adopt it are worthwhile.”

About Mathematica: Mathematica Policy Research seeks to improve public well-being by conducting studies and assisting clients with program evaluation and policy research, survey design and data collection, research assessment and interpretation and program performance/data management. Its clients include foundations, federal and state governments and private-sector and international organizations. The employee-owned company, with offices in Princeton, NJ; Ann Arbor, MI; Cambridge, MA; Chicago, IL; Oakland, CA; and Washington, DC; has conducted some of the most important studies of health care, nutrition, education, international, disability, family support, employment, and early childhood policies and programs.

Contact: Jennifer de Vallance, (202) 484-4692