Reducing Long-Term Cost by Transforming Primary Care

At this time of national focus on the need to simultaneously improve quality and reduce cost, novel solutions are needed. The fragmented healthcare delivery system further adds to the challenge. The key stakeholders—physicians, patients, health insurers, and hospital administrators, as well as the federal government—now recognize the need for healthcare redesign to increase the quality of care while containing the cost of care. In particular, reorienting the current healthcare delivery system to one in which greater emphasis is given to more effective primary care is likely to be an important solution to the problem.

Recently, patient-centered medical homes (PCMHs) have gained attention as a way to re-engineer the care-delivery process. In the broadest sense of the term, PCMHs refer to “provision of comprehensive primary care services that facilitates communication and shared decision-making between the patient, his/her primary care providers, other providers, and the patient’s family.” There is early but growing evidence that PCMHs have the potential to improve care for individuals, improve health of populations, and slow the growth in costs of healthcare by reviving primary care and bringing the patient and family to the center of the care-delivery system (ie, achieving the “triple aim).”

The ultimate goal of PCMHs is to improve patient outcomes via redesigned primary care. The preventive aspect of primary care enhances the value proposition of PCMHs as a long-term intervention. Such an emphasis on primary care, therefore, implies that PCMHs may have the desirable effect of reducing cost of care. The early experiences of the PCMH demonstrations strongly suggest this. In this study, we explicitly explore this possibility by evaluating the effect of ProvenHealth Navigator (PHN), an advanced model of PCMHs developed and implemented by Geisinger Health System (Geisinger), since 2006 on cost of care.