The patient-centered medical home is a team-based model of primary care meant to improve quality, efficiency, and patients’ experiences. Professional associations, payers, policymakers, and other stakeholders have advocated for the transition to medical homes and initiatives are under way across the country to encourage primary care practices to invest in patient registries, enhanced access options, and the other structural changes the model requires. In this study, Commonwealth Fund–supported researchers analyzed practices participating in the Southeastern Pennsylvania Chronic Care initiative, one of the earliest and largest multipayer medical home pilots in the United States, to examine the quality care delivered, use of medical services, and the costs of care.
What the Study Found
Over the duration of the pilot (2008–2011), all participating practices achieved recognition from the National Committee for Quality Assurance for achieving patient-centered medical home status, and most adopted new structural capabilities. For example, the percentage of pilot practices using registries to identify patients overdue for chronic disease care increased from 30 percent to 85 percent, and the percentage using electronic medication prescribing increased from 38 percent to 86 percent. Participation in the pilot was significantly associated with one of 11 quality measures evaluated: nephropathy monitoring in diabetes. The researchers did not find any significant changes in care utilization or costs. The pilot practices averaged bonuses of $92,000 per primary care physician during the three-year intervention.
While the pilot practices did receive enhanced compensation, the researchers note that the practices did not receive direct incentives to contain costs nor feedback on their patients’ utilization of care. Perhaps as a result, few practices increased their night and weekend access capabilities, which could have produced savings by offering patients a less-expensive alternative to emergency departments. Overall, the results of this early program suggest that “medical home interventions may need further refinement.”