I recently came across some interesting data about medical homes and imaging utilization. In this story about practices designated as medical homes by Blue Cross Blue Shield of Michigan (consisting of 1800 physicians in 500 practices), those physicians had a lower utilization of imaging for adults:
Preliminary data suggests designated practices are better managing patient care to improve quality and reduce costs. Medical home practices have a 2 percent lower rate of adult radiology usage than other practices, and a 2.6 percent lower rate of adult inpatient admissions.
Under the medical home model, physician practices are designated patients' "medical home" to coordinate the continuum of care. The practices are redesigned to be more functional and workflow-friendly, and new processes are developed to focus on quality, safety and alternative reimbursement methods. The care model also calls for extensive use of health information technologies, including electronic health records, e-prescribing, clinical decision support, secure messaging and Web portal software.
At first glance, a two percent reduction in imaging utilization isn't that impressive. It could suggest that there isn't a big cost savings opportunity with primary care physicians and imaging utilization. RBMs have reported that primary care physicians often have the highest ratio of appropriate to inappropriate advanced imaging orders; however, PCPs typically don't order a lot of advanced imaging anyway. The imaging they do order is probably more routine (x-ray, ultrasound and echocardiography), potentially more appropriate and less costly. Of course, this is just one example of a medical home program, so it will be important to weigh the experiences of other payers and providers.