- Advanced primary care models such as the patient-centered medical home (PCMH) may contribute to improved population health outcomes and lower costs in accountable care organizations (ACOs), according to a recent report from the Patient-Centered Primary Care Collaborative (PCPCC).
Both PCMHs and ACOs aim to enhance care delivery, albeit through slightly different mechanisms. Accountable care organizations provide the financial framework and performance metrics for reducing costs and creating incentives for better outcomes, while the PCMH offers a detailed model for applying practice transformation strategies to achieve population health management goals.
While many providers combine the two strategies to create advanced primary care delivery organizations, the PCPCC noted that few studies have examined how these models interact to optimize quality and improve population health.
To understand the role PCMHs play in the success or failure of ACOs, the PCPCC enlisted researchers from the Robert Graham Center and IBM Watson Health to examine data on 333 ACOs that participated in the 2014 Medicare Shared Savings Program (MSSP).
The team then separated the organizations into quartiles based on the percentage of physicians within each ACO with experience applying the PCMH model to care delivery.
ACOs in which no physicians had PCMH experience were placed in the first quartile, while the fourth quartile consisted of ACOs in which 43 percent or more had PCMH experience.
After analyzing the differences in cost outcomes among each group, the team found that ACOs in the three upper quartiles, which had progressively higher percentages of PCMH physicians, were more likely to generate savings.
Compared to the lowest quartile, ACOs in the second quartile averaged savings of 1.9 percent. Those in the third quartile showed savings of 1.3 percent, and ACOs in the fourth quartile saved 1.2 percent.
Researchers also compared quality outcomes among the four groups and found that ACOs in the highest quartile outperformed those in the lowest quartile on more than two dozen measures related to performance and outcomes.
The team found that having a higher percentage of PCMH physicians was associated with higher clinical quality scores for preventive screenings and services, including depression and tobacco screenings and smoking cessation interventions.
ACOs with higher percentages of PCMH physicians also had higher quality scores for chronic disease management, including diabetes and coronary artery disease management.
In addition to analyzing MSSP data, the research team conducted qualitative literature reviews to understand the relationship between ACOs, PCMHs, costs, and quality.
The team found that cost outcomes were generally positive, with four of the six academic articles reporting cost savings, one reporting no difference, and one reporting an increase in costs. All six articles reported quality improvements.
These findings have important implications for the future of ACOs, PCMHs, and value-based care, the PCPCC said.
“With 10 percent of the US population in ACOs and growing, and more than 20 percent of primary care physicians practicing in PCMHs, these findings have widespread applicability for public and private policymakers who should consider evolving these programs to promote synergy between them,” the organization wrote.
The PCPCC cited the 2017 evaluation of the Medicare MSSP, which showed that even though only one-third of ACOs in the program reduced spending, the program as a whole outperformed fee-for-service models on most quality measures.
Implementing a strong foundation of advanced primary care within ACOs could help drive care coordination and integration, which could contribute to improved ACO cost saving, the group said.
PCPCC also suggested that PCMHs collaborate with ACOs that have a strong primary care basis to enhance PCMH services.
The results indicate that integrating advanced primary care models, particularly PCMHs, and ACOs can further improve healthcare delivery and enhance population health.
“ACOs and advanced primary care models both strive to improve quality, reduce costs, and put the patient at the center of their care, but each model has evolved separately,” said PCPCC President and CEO Ann Greiner.
“Incorporating advanced primary care in an ACO environment can drive meaningful change.”