Patient-centered medical homes are one of the delivery system innovations encouraged by the Affordable Care Act (ACA). But recent studies present a mixed picture of the effectiveness of medical homes in improving quality and reducing costs through care coordination.
The National Committee for Quality Assurance (NCQA) has been “designating” medical homes since it started its recognition program in 2008. NCQA recognition, however, doesn’t necessarily deliver the anticipated results. “There is criticism that physicians and other providers are more concerned with checking NCQA’s boxes to document processes than with providing coordinated care and achieving better outcomes.” (“Reform Update: Medical-home adoption growing; evidence of effectiveness still elusive,” Modern Healthcare Daily Dose, August 18, 2014)
The medical home should add accountability, ease quality measurement and allow for better tracking of patient tests results and specialist visits. But three recent primary-care studies are not conclusive about the success of medical homes.
- Health Services Research: Compared cost and quality measures for 308 NCQA-recognized medical homes with 1,906 non-recognized practices. Results showed that after receiving NCAQ recognition, total Medicare Payments, acute care payments and ED visits declined compared with non-recognized practices.
- Health Affairs: Researchers concluded that “neither the patient-centered medical home score, nor pay-for-performance incentives, nor the acceptance of risk for the cost of hospital care for the [small] practice’s patients was significantly associated with the ambulatory care-sensitive admission rate.” (This study looked at small physician practices and found one- to two-doctor practices had 33 percent fewer ambulatory care-sensitive hospital admissions than practices with 10 to 19 doctors. Also reported was that physician-owned practices had fewer preventable admissions than hospital-owned practices.)
- Millbank Reports: Concluded that payer alignment and corresponding payment reforms must be in place for medical homes to succeed. The report’s authors noted that typically no single payer can invest enough to make transforming the entire practice cost-effective.
(Report synopses from “Reform Update: Medical-home adoption growing; evidence of effectiveness still elusive,” Modern Healthcare Daily Dose, August 18, 2014)
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A course about physicians by physicians—Todd Sagin, M.D., J.D. and Larry McEvoy, M.D.—it examines how physicians are making the changes necessary for the new business model, and offers unorthodox suggestions to boards and executives about how to work with physicians as the entire organization goes through radical change.
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