One PCMH Pilot, Two Different Results

Researchers found 17 practices operating as "medical homes" in Pennsylvania significantly reduced costs for high-risk patients -- countering negative results published last month that looked at the same patient-centered medical home (PCMH) pilot.

The new paper, published online Monday in the American Journal of Managed Care (AJMC), painted a glowing picture of the future of PCMHs after looking at practices in Pennsylvania's Chronic Care Initiative, a multipayer pilot which gave practices money to become medical homes as certified by the National Committee for Quality Assurance (NCQA).

"This study demonstrated that adoption of the PCMH model was associated with significantly reduced costs and utilization for those members at highest risk, particularly with respect to inpatient care," Susannah Higgins, of Independence Blue Cross in Philadelphia, and colleagues wrote.

Total costs for high-risk patients decreased by $107 per member per month in the first year and by $75 per member per month in the second year under the PCMH practices. Those patients also experienced a significant drop in inpatient admissions in all 3 years, the study found.

But the results tell a different story from what a group of RAND Corporation researchers in Boston reported last month in the Journal of the American Medical Association (JAMA).

They found the practices in the same demonstration project -- Pennsylvania's Chronic Care Initiative -- did little to reduce costs and utilization or improve the quality of care over a 3-year period.

There are some key differences to note between the two studies that make a side-by-side comparison invalid, backers of the PCMH model told MedPage Today.

For starters, the AJMC authors found "no significant cost or utilization differences for the overall population." Their cost savings were seen in high-risk patients -- that small number of patients who consume the majority of healthcare.

The JAMA paper didn't distinguish between such patients, and therefore it was unlikely to show a change, said Marci Nielsen, PhD, chief executive of the Patient-Centered Primary Care Collaborative, a Washington-based stakeholder group for PCMHs.

If you look at the whole population, it is difficult to experience a significant change in spending because the bulk of those patients don't spend much money to start with, Nielsen said. "You look at the folks who see docs often, and that's where you expect to see a change."