Medical Homes Improve Quality, Lower Costs, But Challenges Remain

The use of nationally certified medical homes  to coordinate the care of Connecticut's Medicaid patients has led to improved quality, a 2 percent cut in per person costs, and a 32 percent increase in the number of participating providers during an 18-month period.

The news comes as the state moves forward with plans to jumpstart the medical home  movement in Connecticut with an expanded "Glide Path" program that would assist all practices – not just those that accept Medicaid patients – working to become medical homes. The program, still under development, would require practices to meet national standards.

The state initiative has shed light on the challenges facing Connecticut's medical homes, including the costs of implementing an electronic medical record and care coordination strategies. Experts say medical homes can improve quality, cut costs  and reduce health inequities among all patients, not only those in the state's Medicaid program.

Medical homes refer to a way of delivering primary care that helps people stay healthy by managing chronic conditions and keeping up with preventive care. In a medical home, a team of healthcare providers works closely with patients to coordinate every aspect of care. Providers use electronic tools to remind patients about screenings and track patient outcomes. Some insurers offer certified medical homes financial  incentives for meeting quality and other criteria.

A total of 833 clinicians in 222 practices in Connecticut have been certified as patient-centered medical homes by the National Committee for Quality Assurance (NCQA), the nation's largest credentialing organization. A total of 131 Connecticut practices have purchased the NCQA survey tool in 2014 so far, twice as many as in all of 2013. "That's a strong indication that many practices are getting ready to apply for recognition," said Apoorva Stull, a NCQA spokeswoman.

Connecticut was the first in the nation to adopt the medical home model for Medicaid, the state's health coverage program for the poor.

"Our experts note that the patient-centered medical home approach has had a demonstrable effect on health outcomes and member satisfaction," said David Dearborn, spokesman for the state Department of Social Services (DSS), which administers Medicaid. The improvements in the Medicaid program took place between January 2012 and June 2013.

For example, the quality of care delivered to adult and pediatric Medicaid beneficiaries by certified "patient-centered medical homes" exceeded the quality of care provided by non-medical home practices across a number of areas, according to state statistics.

Children seen in Medicaid medical home practices were over 10 percent more likely to receive recommended EPSDT (early and periodic screening, diagnostic and treatment) screenings. Medical homes also scored better with well child visits, adolescent well-care visits, adult access to preventive health services, annual dental visits, eye and cholesterol screenings for people with diabetes, and managing asthma patients with a history of emergency department visits.