While interventions to transform primary care practices (PCPs) into patient-centered medical homes (PCMHs) are common, but their effectiveness in improving quality and decreasing costs is unclear, according to a study in JAMA.
One of the first, largest, and longest-running multipayor trials of PCMHs in the United States was associated with limited improvements in quality and was not associated with reductions in use of hospital, emergency department (ED), or ambulatory care services or total costs of care over three years, researchers found.
RAND Corporation researchers and colleagues measured associations between participation in the Southeastern Pennsylvania Chronic Care Initiative, a multipayor medical home program, and changes in the quality, utilization, and costs of care. Pilot practices could earn bonus payments for achieving PCMH recognition by the National Committee for Quality Assurance (NCQA). Thirty-two volunteering PCPs participated in the pilot (conducted from June 2008 to May 2011). Using claims data from four participating health plans, the researchers compared changes in care (in each year, relative to before the intervention) for 64,243 patients who were attributed to pilot practices and 55,959 patients attributed to 29 comparison practices. Measured outcomes included performance on 11 quality measures for diabetes, asthma, and preventive care; utilization of hospital, emergency department, and ambulatory care; standardized costs of care.
Pilot practices successfully achieved NCQA recognition and reported structural transformation on a range of capabilities, such as use of registries to identify patients overdue for chronic disease services (increased from 30 percent to 85 percent of pilot practices) and electronic medication prescribing (increased from 38 percent to 86 percent). Pilot practices accumulated average bonuses of $92,000 per primary care physician during the 3-year intervention.
Of the 11 quality measures evaluated, pilot participation was significantly associated with greater performance improvement, relative to comparison practices, on only l measure: monitoring for kidney disease in diabetes. There were no other statistically significant differences in measures of utilization, costs of care, or rates of multiple same-year hospitalizations or emergency department visits.
The authors report that a multipayor medical home pilot, in which participating practices adopted new structural capabilities and received NCQA certification, was associated with limited improvements in quality and was not associated with reductions in utilization of hospital, ED, or ambulatory care services or total costs over 3 years.
Despite widespread enthusiasm for the medical home concept, few peer-reviewed publications have found that transforming primary care practices into medical homes produces measurable improvements in the quality and efficiency of care, researchers conclude.
Source: JAMA, February 25, 2014
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