Noise to Signal Ratio in the Assessment of the Medical Home

From time to time, the Population Health Blog's consulting business generates supplemental income.  When that happens, it gets dropped into the PHB's cash flow and life goes on.

Months later, is the PHB household better off?  On one hand, every little bit helps.  On the other, total income is the result of many jobs and total well-being is only partially a function of the PHB's bank account.  In other words, it's difficult to gauge the one time contribution of a consulting gig to the "outcome" of total income.

It's a classic "noise" (total income) to "signal" (the gig) conundrum.

That's how the PHB addressed the problem of this disappointing JAMA article in its conversations with colleagues at today's Medical Home Summit meeting.  As readers will recall, this JAMA research showed no statistically significant impact on claims expense for all patients who were attributed to a medical home clinic compared to a parallel population of patients attributed to non-medical home clinics.
 
To the PHB, "total claims expense" is akin to total income, while the impact on a smaller subpopulation segment of patients with chronic conditions who were at special risk is the "gig."  Because of the overwhelming "noise" of insurance claims involving tens of thousands of patients, it's practically impossible to discern the benefit of the medical home for the smaller number of vulnerable patients.

The lesson?  While all patients assigned to a medical home clinic won't benefit, some could.  Until we understand that, we won't really know the return on investment of this approach to care.