PCMH pilot demonstrated minimal quality improvement, no cost savings

A pilot project found that implementation of a medical home practice model improved quality only minimally and did not reduce health care costs or utilization.

The project involved 32 primary care practices in southeastern Pennsylvania, followed from 2008 to 2011. During the project, the pilot practices received technical assistance to develop new tools such as disease registries and were financially rewarded by the 6 participating payers for achieving medical home recognition from the National Committee for Quality Assurance (NCQA). Using claims data, researchers compared changes in quality, utilization and costs for about 64,000 patients in the pilot practices with 56,000 patients from 29 similar practices that hadn't volunteered for the pilot.

Although the practices successfully achieved NCQA recognition, their performance improved significantly on only 1 of 11 studied quality measures: nephropathy screening diabetes (82.7% vs. 71.7%). The pilots' patients didn't reduce their use of hospital, emergency department or ambulatory care services, or total health care costs, over the 3 years. Results were published in the Feb. 26 Journal of the American Medical Association.

The study authors noted that one explanation may be that practices volunteering for a pilot project might have had little room for improvement in their quality of care. The project's focus on NCQA recognition also might have distracted from other possible improvements, including those that would have reduced costs and utilizations. The practices weren't given incentives or feedback related to their patients' utilization of care; a quarter of the practices didn't receive hospital discharge summaries. The study authors concluded that “medical home interventions may need further refinement.”

Supporters of the patient-centered medical home (PCMH) model shouldn't be too disappointed by the results of the study, according to an accompanying editorial. The lack of effect found in the study may indicate that PCMH interventions need to be focused on a more specific patient population. Intensive interventions should be targeted at patients with a history of high utilization and cost, the editorialist suggested.

“Before confidently promoting the PCMH as a core component of health care reform, it is necessary to better understand which features and combination of features of the PCMH are most effective for which populations and in what settings,” the editorial said.