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Patient-centered medical homes cut costs, improve quality through collaboration, evidence shows

In most cases, PCMHs resulted in cost reduction, quality improvement and utilization, although in some areas results were mixed.

Jeff Lagasse, Associate Editor

New evidence shows a link between patient-centered medical homes and improved quality at a lower cost -- provided there's an adequate investment in primary care, and strong collaboration between the payer and provider.

Released this week by the Patient-Centered Primary Care Collective, the study reviewed 45 peer-reviewed reports and found that, in most cases, PCMHs resulted in cost reduction, quality improvement and utilization, although in some areas results were mixed.

Overall, the analysis of the reports showed that the longer a practice had been transformed, and the higher the risk of the patient pool in terms of comorbid conditions, the greater the effect on cost savings.

Quality results weren't as conclusive. Looking at state-specific data and data from the Centers for Medicare and Medicaid Services, PCPCC found that there was a general trend toward PCMHs improving quality, though some data showed that there was no statistically significant effect.

[Also: Price transparency for inpatient labratory tests has little effect on clinician ordering behavior, JAMA says]

By contrast, studies uniformly showed that PCMHs had a positive effect on patient satisfaction. Team-based interventions, including case management, and having a usual source of care, have positively impacted the patient experience.

Utilization outcomes were mixed. Most studies and state reports showed an increase in outpatient visits, but that wasn't always tied to a decrease in emergency room visits or inpatient stays.

A partnership between Blue Cross Blue Shield of Michigan and local physician organizations has resulted in one of the largest and longest-running patient-centered experiences in the country, and according to PCPCC, there were several factors in that success. With numerous stakeholders on board, program leaders pushed an incremental approach that rewarded physicians' efforts, and multi-payer support was engendered by the five-year Michigan Multi-Payer Advanced Primary Care Practice Demonstration Program.

The report said it's advisable to make primary care attractive to medical students, as most are attracted to the salary and status that comes with being a specialist, drawing them away from family medicine. PCPCC also said primary care should be a key part of insurance benefits.

Twitter: @JELagasse

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