A recent report from the Patient-Centered Primary Care Collaborative (PCPCC) takes a look at the most up-to-date studies on PCMHs and other primary care transformation models to see how well they're measuring up to the goals of reducing cost, improving quality of care, and rightsizing utilization.
Spoiler alert: The report found that the PCMH model does demonstrate improvements in all three domains —but results vary widely across programs.
Quality, cost, and utilization impact varies—and the model takes time to deliver ROI
Primary care innovation lowers overall costs—especially for those serving more complex patients. While results varied by state, on the whole, the PCPCC team found that that "becoming or advancing one's status as a PCMH was associated with decreases in overall cost." Despite increases in outpatient visits among PCMH patients, the decreases in inpatient utilization yielded net cost savings for this group. In particular, clinics that had been in operation for four or more years and clinics serving more clinically complex patients typically realized the most significant cost savings.
PCMH patients more likely to have increased PCP utilization, but that's not necessarily associated with linked decreases in ED utilization. Some studies, including two out of three of those evaluating Medicaid PCMH initiatives, showed reduced ED and hospital utilization among PCMH patients. While the PCPCC was hesitant to draw causative conclusions from these outcomes, it noted that a clinic focused on being patient-centered and on advancing care coordination may see reduced readmissions and ED utilization.
- Program highlight: Michigan's PCMH transformation program has shown decreased ED (-11.2%) and hospital utilization(-13.9%) for PCMH-targeted conditions
Improvement in quality outcomes least significant. Each study reported mild or no improvement on quality measures. Studies used a wide range of metrics to evaluate quality, few of which overlapped, making it difficult for the PCPCC to arrive at a conclusive evaluation. Metrics used to track quality of care included:
- Receipt of preventive services, such as cancer screenings or flu vaccine
- Clinical measures, such as LDL or hypertension control
- Disease management measures, such as medication adherence and post-discharge follow up
So what makes for an effective program?
As you look to start a new PCMH or enhance an existing practice, keep these two best practices in mind:
1. You can only be "all things to some people." Target the model to patients most likely to require the enhanced level of support.
Like we've mentioned in the past, the PCMH model doesn't make sense for all patients. Complex patients dealing with one or more chronic conditions—also known as rising-risk patients—are best-suited for participation in a PCMH. Meanwhile, many high-risk patients require more tailored support than a PCMH can offer, while low-risk patients require less.
2. Take advantage of human capital. Deploy a multidisciplinary team.
To improve quality, reduce cost, and right-size utilization, the enhanced team-based care model as a critical key to success, the literature suggests. Incorporating non-traditional team members as needed, like care managers, pharmacists, community health workers, and behavioral health specialists was associated with improvements in cost, quality, and utilization, and provided the added bonus of positively impacting both patient and provider satisfaction. These are important tenets of health care's foundational aims.
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