May 2017 -- As healthcare spending continues to consume a substantial portion of public and private budgets, policymakers have searched for innovative ways to control unnecessary utilization and costs while enhancing quality and outcomes. The patient-centered medical home (PCMH) model, which promotes health maintenance, prevention, and care coordination and management through integrated systems of healthcare, has fittingly become a leading approach nationally to transform the way healthcare is being delivered.
In a recently released study in the health policy journal, Health Affairs, researchers from Harvard University, joined by Onpoint, conducted a meta-analysis of findings from 11 different PCMH initiatives, including the Vermont Blueprint for Health’s advanced primary care program, to identify whether the programs are successfully reducing the cost of care while improving quality and the patient experience.
To draw associations between PCMH performance and overall transformation impact, the study, “Synthesis of Research on Patient-Centered Medical Homes Brings Systematic Differences into Relief,” evaluates several outcomes, including primary, specialist, inpatient, and emergency department utilization; cancer screening; dilated eye exams and hemoglobin A1c testing for diabetes patients; and hospital admissions and potentially avoidable emergency department visits.
Overall, for all patients, while the study did not find an association between PCMH transformation and total healthcare spending, it did identify a positive association for two health outcomes: increased cervical cancer screening and specialty visit reductions. For a subset of higher-morbidity patients, the study also found a reduction in overall spending and a positive association for increased breast cancer screening.
The results of this study indicate that, on average across the 11 examined PCMH initiatives, “PCMH transformation did not have its intended effects on cost, utilization, and quality.” The authors note that wide discrepancies between practices in their outcomes indicate that there may be variation in the implementation and emphasis of some of the PCMH model’s core values such as care coordination. The study suggests that PCMH transformation may not be “a uniform, standard-dose ‘pill’ for what ails the US medical system.”
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