Wednesday, June 18, 2014

The Cost-Saving Elevator-Pitch for the Patient Centered Medical Home

Ready, set, elevator, go!
Over the last year, several colleagues have asked the Population Health Blog to compactly summarize the economic return for the Patient Centered Medical Home (PCMH).

Here's the PHB's elevator speech: 

The PCMH comes down to two distinct - and separate - propositions:

1. "Reduce avoidable costs" by only applying the team-based care management and coordination to persons with all three of the following: a) chronic illness who b) are at high risk for future claims and c) are amenable to change.*  All three must be present. This cohort typically represents a small, but "high return potential" fraction of a population.
 
The temptation is to blanket all patients with medical home resources, which increases program as well as claims costs and does little to bend the total cost curve.  The "disease management" industry learned about "care creep" the hard way.

2. "Increase value" by enhancing quality and/or the experience of care with a modest - and relatively affordable - increases in costs. The relative increase in quality/experience is greater than the corresponding increase in program and claims costs, and represents a good deal for the health care dollar.

The temptation is to believe that quality/experience improvements lead to lower costs.  Once again, the "disease management" industry learned about this the hard way. 

* By the way, if the elevator ride is long, the PHB recommends pointing out that 1) predictive modeling/risk stratification can find the high risk persons and that 2) "change" includes modifying patient behaviors.

Image from Wikipedia

1 comment:

Al Lewis said...

Hi Jan,

Looks like you're kinda coming back from the dark side here, so welcome to the "Welligentsia." Costs do in fact go up in the one statewide experiment (NC) with enough data. but it is not quite clear that this is "good."

Also the Paladina Health PCMH outcomes numbers prove the opposite as well, if you simply look hard at them, which of course no one other than me ever does...