Multipayer medical home pilot program sees ED visit reductions

A 9.3 percent reduction in patients’ use of the emergency department (ED) was attributable to the use of a multipayer, patient-centered medical home (PCMH) pilot program in the state of Colorado over a three year period. According to researchers at Harvard University and in a report supported by the Commonwealth Fund, researchers found that although there were no overall cost savings for the medical practices or patients, both ED use and primary care visits realized a sustained reduction over the baseline during this time frame.

Background

The PCMH aims to improve health outcomes for patients, particularly those with multiple or complex care needs, by delivering primary care services in a proactive and coordinated system. In addition, the PCMH attempts to lower costs, specifically by diminishing the need for expensive hospital stays and ED visits. According to the researchers, few prior studies have evaluated the model beyond two years, even though evidence has suggested that it can take years for medical practices to become PCMHs. In the current study, researchers evaluated a pilot program involving 15 PCMH practices in Colorado, including 15 medium-sized practices with 51 physicians, 35 nurse practitioners and physician assistants, and 205 staff, serving approximately 98,000 patients both prior to the program’s launch and then again at two and three years.

Findings

Participating PCMH practices reduced patients’ use of the ED by 7.9 percent or 1.4 visits per thousand member-months during the first two years of observation. At the end of three years, the reduction increased to a total 9.3 percent drop from the baseline or 1.6 fewer ED visits per thousand member-months. Patients with two or more illnesses saw an even more pronounced ED visit reduction of 10.3 percent from the baseline in the rate of hospital admissions for conditions that could have been avoided if timely treatment had been provided in an ambulatory care setting.

In terms of costs, the PCMH program reduced costs to the ED by 11.8 percent or $3.50 per member per month. For patients with two or more conditions, the reduction was 14.5 percent or $6.61 per member per month. During the study’s three year time frame, participating PCMHs also saw a decline of 4.2 primary care visits per thousand-member months.

Although the PCMH pilot program helped to reduce hospital admissions and ED use in Colorado over the three year period, the researchers noted that quality measures improvements were still mixed.