Can the Patient-Centered Medical Home Help Achieve Savings?

In order for a primary care provider to attain recognition as a patient-centered medical home (PCMH), it has to undergo a number of significant changes to its workflows and processes, including expanding office hours, leveraging health IT improve care coordination, and developing more sustained contact with patients.

While these efforts are widely recognized as successful ways to raise the level of care quality, the truth is that they aren’t always cheap to get into gear.  Software and hardware purchases, additional staff hires, and even keeping the lights on for an extra few hours a week all have their built-in costs, and some providers worry that the investment won’t be worth the return.

However, the patient-centered medical home has a growing body of evidence-based research to back up the idea that improving care quality at the primary care level can have measurable positive impacts on healthcare spending that benefit multiple points on thecare continuum.

In this installment of HealthITAnalytics.com’s practice transformation series, Marci Nielsen, PhD, MPH, CEO of the Patient-Centered Primary Care Collaborative (PCPCC) helps us examine why it might be worth it to take the leap into the patient-centered medical home model as a way to trim costs from the healthcare system at large – and how primary care providers can accrue some of those savings for themselves.

Emergency department utilization is one of the first things to decrease when primary care gets more comprehensive, and it’s as simple as keeping the doors open longer.  “It is most common when you start to implement pieces of the PCMH that you start to improve care coordination and access to care for patients,” Nielsen said.  “So you’re putting weekend hours and evening hours into your schedule, and accordingly, you’ve got fewer people going into the emergency room.  So we see those metrics change fairly quickly.”

One study, published in the Annals of Emergency Medicine, found a significantly slower growth rate in ED visits among Medicare patients who received care in a PCMH setting with savings of more than $50 per patient after just one year as a patient-centered medical home.

And according to a study of studies conducted by the PCPCC in February, the PCMH is associated with significant reductions in ED use almost across the board.  In the Patient Aligned Care Team (PACT) initiative, the VA’s equivalent of the PCMH, patients experienced a 46 percent lower ED utilization rate when they partook in “continuity visits” with their PCP.  Chronic disease patients at New York-Presbyterian Regional Health Collaborative were nearly 30 percent less likely to visit the ED and 36 percent less likely to experience a 30-day hospital readmission.