The following is a quote from a published study on the Patient Centered Medical Home (PCMH) that just appeared in the American Journal of Managed Care:
‘Totaling costs across all components of care, we found no statistically significant overall cost differences between the PCMH and other clinics.’
That’s right. In this 12 month prospective, comparative, pre-post study that compared economic, clinic and other outcomes from a single PCMH clinic versus 19 control clinics, the PCMH did not save any money.
The study quite instructive on how extensive a PCMH redesign of a primary care clinic can be. A single metropolitan Seattle primary care practice was converted to a PCMH by a) reducing the physician panel from an average of 2327 to 1800 patients, b) expanding appointment times from 20 to 30 minutes, c) increasing physician support staffing, d) starting team huddles, e) instituting pre-visit outreach and chart reviews, f) issuing patient-centered quality deficiency reports, g) starting e-mail and telephone encounters (as an alternative or complement to in-person visits) and h) using on team-based rapid process improvement. Participating physicians were exempted from RVU-based adjustments. Last but not least, the most dreaded of interventions known to healthcare providers was also used: workshops. Whats' more, there were two of them.
One year later, per member per year (PMPY) costs for the PCMH clinic was $6089 versus $6107 in the control clinics. While there was a $17 difference, it wasn’t statistically significant.
A host of other outcomes including visit types and numbers, patient and provider satisfaction (continuity for the patients and ‘burnout’ for the provider staff) and composite HEDIS measures were also studied. The detail is mind-numbing but can be summarized by saying that the PCMH performed better when it came to quality.
The Disease Management Care Blog isn't convinced that this is enough to push the DMCB into the mainstream of patient primary care or elevate it as a candidate for healthcare reform. That's because of questionable:
Generalizability: Not only was this Group Health Cooperative, but GHC chose its best clinic. If the best of the best couldn't save money, how likely is it that any of the other pilots will save money? How likely is it that GHC's experience could be replicated in other settings?
Given the relentless increase in cost inflation, the DMCB doubts stakeholders, the Congressional Budget Office or reform advocates will be favorably impressed.