PCMH model may make its mark on high-risk patients

A patient-centered medical home (PCMH) pilot in Pennsylvania was found to significantly reduce costs for high-risk patients, according to a report finding very different results from an analysis published a month ago on the same pilot project.

Previously, a study in the Journal of the American Medical Association reported that implementation of a medical home practice model improved quality only minimally and did not reduce health care costs or utilization in 32 practices in the greater Philadelphia area.

The new paper, published online March 24 in the American Journal of Managed Care, instead said that 17 practices within the pilot project had significantly reduced costs and utilization for the highest-risk patients, particularly with respect to inpatient care.

Total per-member per-month costs decreased significantly more for the PCMH group than for controls in the high-risk group, with the PCMH group seeing an adjusted total savings of $107 in the first year and $75 in the second, driven by lower inpatient costs, the report said. The PCMH group experienced a significantly greater reduction in inpatient admissions compared to the control group, 61 hospitalizations per thousand in the first year, 48 in the second, and 94 in the third.

“The findings of this study add new texture to the existing PCMH literature,” the authors wrote. For patients with highest risk scores in the pool of matched patients and practices, PCMH model adoption was shown to lead to a significant relative reduction in total costs in years 1 and 2 and significantly lower numbers of inpatient admissions in all 3 years.

“This suggests that the average patient may not be the relevant unit of observation for evaluating the impact of PCMH adoption,” the authors wrote. “Rather, high risk patients with multiple comorbidities are the most logical targets for interventions aimed at supporting self-management, conveying test results in a timely and clear fashion, and coordinating follow-up and specialist care. Researchers may miss cost and utilization improvements if they confine their analyses to the typical patient, since health care costs are primarily driven by relatively rare events concentrated in few individuals. For example, during the baseline year, all cases and controls had 73 and 78 admissions per 1,000 patients, respectively; but among the high-risk pool, these numbers increased to 566 and 540.”