Results from patient-centered medical homes study ‘significant’

Little evidence exists supporting the case for patient-centered medical homes (PCMHs), leaving decision-makers’ opinions on their use mixed. A recent study, the paper for which appeared in the March issue of Health Affairs, looked at the findings from 11 major PCMH evaluations in eight states to provide estimates of PCMH impact on utilization, cost and quality. The results were “significant.”

What is a PCMH?

Also referred to as a primary care medical home, advanced primary care, or a healthcare home, the patient-centered medical home model aims to reduce spending and improve quality while emphasizing coordinated, patient-centered care. HHS’ Agency for Healthcare Research and Quality (AHRQ) provides five functions or attributes of a PCMH:

1. Comprehensive care: The PCMH must meet the needs of the large majority of a patient’s physical and mental health needs, i.e., prevention and wellness, acute care, and chronic care.
2. Patient-centered: Health care must be relationship-based with an orientation toward treating the whole person, supporting patients and their families managing and organizing their own care.
3. Coordinated care: Care must be coordinated across the broader health care system, encompassing specialty care, hospitals, home health care, and community services and supports, particularly important during transitions between sites of care.
4. Accessible services: A medical home must deliver shorter wait times for urgent needs, better in-person hours, around-the-clock access (telephone or electronic) access to a care team member, and alternative methods of communication.
5. Quality and safety: Medical homes must show a commitment to quality and quality improvement, use evidence-based medical and clinical decision-support tools to share decision-making with patients and families, engage in performance measurement and improvement, measuring and responding to patient experiences and satisfaction, and practice population health management.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-2) calls for “increased quality, efficiency, and clinical practice metrics that existing models such as the PCMH support,” according to letter to then-Acting Administrator of CMS, Andy Slavitt, when the American Academy of Family Physicians and other organizations requested that CMS affirm PCMHs as an eligible alternative payment model (APM). The study authors point to PCMHs being one of the APMs under MACRA, and specifically that MACRA’s Comprehensive Primary Care Initiative (CPCI) “will become a core feature of the Medicare payment system.”

Findings of the study

The study found that PCMH evaluations varied significantly across the 11 major evaluations studies. PCMH resulted in reduced spending (4.2 percent reduction) and improvements in breast cancer screening rates for high-needs patients (1.4 percent increase), lower use of specialist visits (1.5 percent reduction), and increased cervical screening for all patients (1.2 percent increase). The results of this study, combined with mixed results from earlier studies, the study authors note, show that how a PCMH is implemented is critical to achieving the desired impact on primary care. “PCMH initiatives are not ‘one size fits all.’”

The study authors note that while there are a wide variety of approaches to PCMH implementation today, under the CPCI, practices operating a PCMH will share a single payment models and other standard features, so there will be fewer differences. The study authors noted that “identification of the components of PCMHs likely to improve outcomes is critical to decisions about investing resources in primary care.”