Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

Evidence for PCMH success builds with lower costs, ED visits

By Jennifer Bresnick

- The patient-centered medical home (PCMH) model has been proven successful in reducing overall healthcare spending, unnecessary emergency department visits, and inpatient admissions in 61% of peer-reviewed cases while improving overall population health, according to the 2012-2013 annual report of the Patient-Centered Primary Care Collaborative (PCPCC).  Commercial health plans are increasingly putting their spending into primary care as a way to slash costs across the system, leading the industry away from fee-for-service reimbursements and towards a higher quality, value-based payment structure relying on data-driven care coordination and population health management.

“Paying for a healthcare system that invests in primary care and the PCMH is imperative,” the report says.  “The findings are indeed encouraging and the evidence base for the model continues to build at a rapid pace.  While we need to be cautious about over-promising what the PCMH alone can deliver, our review of recent literature affirmatively shows improvements across a number of categories.”

By examining academic and peer-reviewed literature as well as industry reports, PCPCC was able to find proof that a care team based around a primary care provider combined with pay-for-performance incentives is effective in improving overall healthcare quality, raising patient satisfaction, and expanding access to preventative care services across the population.

The Colorado Multi-Payer PCMH Pilot, for example, saw 15% fewer ED visits, 18% fewer inpatient admissions, and a return on investment of 4.5 dollars for every one dollar spent.  In New York and New Jersey, practices increased breast cancer screenings by up to 3.5% and boosted blood pressure control and A1c testing by 21% and 5% respectively.



Payers also reported high satisfaction with new delivery models.  BlueCross BlueShield of Alabama achieved an estimated cost savings of $1.9 million in their Medical Home Program, and saw a 13.6% higher rate of colorectal cancer screenings and 11.8% more breast cancer screenings.  CareFirst BlueCross BlueShield in Maryland reported a whopping $98 million in total cost saving and brought quality scores for PCMH panels up by 9.3% over one year.

“As evaluations of ACOs, integrated health systems, and the medical neighborhood continue, the PCMH will be essential to driving improvements in cost, quality, and outcomes,” the report concludes.  “Further supporting the PCMH, recent research finds that the longer a PCMH has been in place, the greater the cost savings and improvement in quality and outcomes.  More robust analyses regarding how PCMHs function, transform, and improve outcomes for all patients and their families are critical to the long-term success of primary care, as well as helping the US to achieve much needed, broad-based delivery reform.”



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