Medical home model designed to boost quality, reduce national healthcare costs is falling short
A new approach to patient-centered medical home care focused on addressing “high-value” elements (HVE) does not drop healthcare costs for patients treated at primary care practices, according to a new study.
Clinics utilizing the new model targeted aspects of care that were projected to improve outcomes while lowering costs, such as team-based care for managing chronic diseases. Compared to non-HVE clinics, however, the redesigned approach led to fewer hospitalizations but also more visits to emergency departments and no change in costs, experts reported in the February issue of Medical Care.
The patient-centered medical home model focuses on offering enhanced access to comprehensive, coordinated, team care and is used by many providers. In Oregon alone, more than half of primary care practices utilize this approach.
While prior work has demonstrated meaningful patient experience benefits, these new findings cast doubt on a key part of the nation’s effort to reduce healthcare costs.
“The results of this randomized study are important: in the face of other substantial gaps in PCMH evidence to reduce cost and utilization, [the results] should push model developers and policymakers to consider substantially different approaches,” Joshua Colasurdo, BS, with Oregon Health & Sciences University, and colleagues wrote.
For the study, the team randomly assigned eight clinics to receive training in the HVE approach or follow standard PCMH techniques. Organizations using the new model chose high-value care targets from a curated list that included things such as offering access to in-person care at least 12 hours per week outside of normal hours and providing more than 10% of patients with targeted educational resources, among many other options.
Looking at healthcare cost and utilization data from more than 16,000 patients, there was no significant difference between HVE and non-HVE clinics. In fact, spending climbed for both cohorts, the team reported.
Outside of a few limitations, including a highly complex study and a small number of practices, the authors suggest the benefits of PCMH models still remain largely unproven.
“The ability to change individual trajectories of patients’ health with PCMH and advanced primary care models may be limited without organizationally focused team-driven and patient-driven approaches; programs that facilitate structured care planning with clear tailoring and patient-directed goal setting may also overcome the challenges found in this work,” the authors concluded.
You can read the entire study here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.