Medical home study: the longer in, the more savings

There is early but growing evidence that patient-centered medical homes (PCMHs) have the potential to improve care for individuals, the health of populations and slow the growth in costs of healthcare by reviving primary care and bringing the patient and family to the center of the care-delivery system (ie, achieving the “triple aim), according to an article in the March issue of the American Journal of Managed Care.

Daniel D. Maeng, PhD, Geisinger Health System, Danville, Pa., and colleagues studied the effect of ProvenHealth Navigator (PHN), an advanced model of PCMHs developed and implemented by Geisinger since 2006 on cost of care. "This analysis focuses on individual members’ exposure to PHN by measuring how long a member has been exposed to a PHN site and examining whether a prolonged exposure to PHN is associated with a lower cost of care over time. It is expected that the longer the patient has been exposed to a PHN site, the greater the cost savings," the authors wrote.

Data originated from GHP’s claims database covering the period between January 1, 2006, and December 31, 2010. The study sample was restricted to GHP’s Medicare Advantage plan members who were at least 65 years of age during the study period (because PHN had focused primarily on the Medicare population during this time).

According to the article, two measures of PHN exposure were developed. First, a member-level PHN exposure measure was calculated as the number of months a member had been enrolled in a PHN clinic as of a given time. Second, a clinic-level PHN exposure measure was also calculated as the number of months in which the clinic had been a PHN site as of a given period since its PHN conversion.

"PCMHs as embodied in Geisinger’s PHN initiative can reduce cost by providing patients improved care coordination, enhanced access to primary care providers, and more effective and efficient disease and case management," concluded the article. "There may indeed be downstream benefits of PCMHs which manifest themselves at the individual level only after a considerable length of exposure.

While the ROI estimates did not reach statistical significance during this study period, the results still suggest that as more members get longer exposure to PHN the accrued savings to GHP will likely increase beyond the level shown in this analysis, and the net savings as demonstrated by ROI may eventually achieve statistical significance. As such, in order to be able to detect any measurable success of PCMHs in terms of significant and sustainable cost savings, a continued investment in PCMHs as well as patience is likely to be necessary."