Patient-centered medical Homes (PCMHs) reduce emergency department visits for the chronically ill by nearly 8 percent, according to a study authored by Independence Blue Cross (Independence) and CTI Clinical Trial and Consulting Services (CTI), and published by Health Services Research.
Using claims data from approximately 460,000 Independence beneficiaries enrolled in 280 primary care practices, researchers found that the transition to a medical home was associated with a statistically significant 5 to 8 percent reduction in ED utilization. This finding is specific to patients with chronic illness(es) having one or more ED visits in any given year. These reductions were most evident among patients with diabetes, who experienced a 9.5 to 12 percent reduction.
Researchers state that PCMH’s expanded access was not the reason for improved ED utilization; instead, it was better management of chronic conditions. In particular, the most significant reductions in ED visits were for patients with either hypertension or diabetes.
PCMHs improve patient health and lower costs through a team-oriented approach to primary care. This includes more coordinated care among all healthcare professionals, electronic health records (EHRs) to better track care, open scheduling to allow for more flexibility in seeing patients when they need care, and more interaction with the physician and staff between appointments to make sure scheduled tests and consultations occurred.
Medical homes are particularly beneficial to the high-risk or chronically ill population because of the added resources they receive, including care managers and dieticians that provide regular outreach from doctors and their staff about test reminders, preventive care, and other information and support. Care is also more coordinated and problems are addressed quickly so they don’t become worse and result in an emergency room visit or complication, the report states.
Some patients’ needs could be addressed in a lower-intensity setting like retail or urgent care clinics, researchers added. Additionally, patients with chronic illnesses may be seeking treatment for acute illness episodes that might have been avoided through better disease management. Medical homes focus on improving patient access, care coordination, and illness management and have generated considerable interest as a vehicle for improving patient care, especially among those individuals needing treatment for chronic illnesses, the report continues.
Source: Independence Blue Cross, September 3, 2014
Generating Medical Home Savings and Quality Improvements Through Outcome-Based Measures presents the details of its PCMH designation requirements and the system of rewards and incentives that has produced results for the plan, the PCMH practices and its members.