James A. Wiley, Diane R. Rittenhouse, Stephen M. Shortell, Lawrence P. Casalino, Patricia P. Ramsay, Salma Bibi, Andrew M. Ryan, Kennon R. Copeland, and Jeffrey A. Alexander
J. A. Wiley, D. R. Rittenhouse, S. M. Shortell et al., “Managing Chronic Illness: Physician Practices Increased the Use of Care Management and Medical Home Processes,” Health Affairs, Jan. 2015 34(1):78–86.
Through better management of patients with chronic disease, health care providers not only can improve health outcomes but they can control the high cost of treating illnesses like diabetes, asthma, congestive heart failure, and depression. To encourage better care management, there are a number of incentives for physician practices to form patient-centered medical homes, which use electronic health records, patient registries, care teams, and other processes that have been shown to improve care for chronically ill patients while helping to control costs.
Using national survey data collected between 2006 and 2013 from physician practices of all sizes, Commonwealth Fund–supported researchers found that practices overall increased their use of recommended medical home processes by at least 40 percent during this period. Larger practices (20 or more physicians) used more of these processes than small and medium-sized practices. Incentives such as pay-for-performance and public reporting of data on patients’ experiences and quality of care were associated with higher medical home scores.
Yet even among high-scoring practices, most used fewer than half of the processes recommended for optimal chronic care management. Among the processes with the lowest levels of adoption were use of nurse care managers, registries, and patient reminders, as well as efforts to improve access to care.
Payment incentives and public reporting may encourage the adoption of medical home processes, especially by large practices that have more resources to respond quickly. Small practices, as well as practices serving vulnerable communities, may need financial and technical assistance to improve chronic care; these practices would likely benefit from participating in larger independent practice associations or accountable care organizations.