Want to be an expert on the latest news about the Patient Centered Medical Home? Well, in addition to regularly reading the Disease Management Care Blog, you could be the U.S. President or one of his health care advisors and simply ask the folks from the Patient-Centered Primary Care Collaborative (PCPCC) to stop by and provide their insights. Or better yet, you could plan on going to the October 22 PCPCC Annual Summit: All Eyes On the PCMH that will be at the Washington Convention Center from 8:00 - 4:30. You can register here. The Agenda is packed with informative experts, Washington DC is a beautiful city in the Fall and what's more, you can say hi to the DMCB, which will be sitting in the back and taking notes.This is an exciting time for the PCMH. News from the many commercial insurer pilots should start arriving soon. What's more, CMS's Medical Home Demo is going to be getting underway in the not too distant future. Last but not least, PCMH pilots are highly likely to survive intact in the current versions health reform legislation.
Even if you're not a Presidential advisor and cannot make it to D.C. three weeks from now, thanks to the DMCB and the PCPCC, you now have access to their list of peer reviewed publications or analyses, which are below with links to what you'll need and more. Thanks to keeping the DMCB on your reading list, you can now access and review the same established evidence base that was shared with the White House.
The folks at PCPCC were kind to provide these to the DMCB - which is greatly appreciated.....
Group Health Cooperative of Puget Sound - Reid R, Fishman P, Yu O et al: A patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Manag Care. 2009;15(9):e71-e87. Reviewed previously by the DMCB, this twelve month study comparing a PCMH clinic with control clinics found an additional cost of $16 per patient per year was associated with offsetting cost reductions, with the net result being no overall increase in total costs with a reduction in inpatient and emergency room costs with climbs in HEDIS-defined quality. (Link)
Community Care of North Carolina - Steiner, B.D et al: Community Care of North Carolina: Improving care through community health networks. Ann Fam Med 2008;6:361-367. Community Care of North Carolina found that circuit-riding nurses and compensating primary care offices for PCMH-based care coordination was associated with savings totalling $135 million for TANF-linked populations and $400 million for the aged, blind and disabled population. Likewise examined by the DMCB here, here, and here. (Link)
Health Partners uses "BestCare" practices to improve care and outcomes, reduce costs. It must be true if the Institute for Healthcare Improvement says Health Partner's medical homes had a 39% decrease in emergency room visits, a 24% decrease in admissions and a 20% decrease in inpatient costs for behavioral health patients. Diabetes care measures increased and clinic waiting times decreased. (Link)
Geisinger Health System and ProvenHealth Navigator. As far as the DMCB is aware, it's not been published in any formal or peer review setting, but at a recent DMAA Forum 09 meeting, their powerpoint quoted a 7% reduction in overall costs, a 25% reduction in readmissions, a 15% reduction in admissions accompanied by quality increases in diabetes, coronary artery disease, preventive care and member satisfaction. It hears a publication is in the works somewhere. (Link)
Johns Hopkins Guided Care PCMH Model - Leff B, Reider L, Frick K et al: Guided care and the cost of complex health care: a preliminary report. Am J Managed Care 2009; 15:555-559. The folks at Hopkins call this version of the PCMH 'Guided Care.' Primary care clinics owned by Hopkins and Kaiser had 'pods' consisting of 2-5 primary care physicians and 7 were randomized to an intervention consisting of a care manager nurse while 7 others served as controls. Based on 8 months of data involving 485 patients in the PCMH pods versus the 415 patients in the usual care pods, the intervention patients had a 24% reduction in total hospital inpatient days and a 15% fewer ER visits. Based on a Medicare fee schedule, that's an annual savings of $1364 per patient. (Link)
Genesee Health Plan. In another report from the Institute for Healthcare Improvement, the Genesys Health System started the Genesee Health Plan to serve 25,000 previously uninsured adults in Michigan. The insurance benefit emphasized the PCMH and, compared to competing health plans, Genesee had a 10% to 25% lower cost, declining ER utilization and increased enrollee healthy behaviors. (Link)
Colorado Medical Home. The State's Medicaid program enrolled 88,000 Medicaid and 62,000 CHP+ children in medical homes as of March 1, 2009. Since then, ER visits and hospitalizations were lower with annual costs being $785 for PCMH children compared with $1,000 for children being cared for outside of a PCMH. In an evaluation specifically examining children in Denver with chronic conditions, PCMH children had lower median costs ($2,275) than those not enrolled in a PCMH practice ($3,404). More children also had well child visits. (Link)
Intermountain Healthcare Medical Group Care Management Plus PCMH Model - Dorr DA, Wilcox AB, Brunker CP, et al: The effect of technology-supported, multidisease care management on the mortality and hospitalization of seniors. J Am Geriatr Soc. 2008;56(12):2195-202. Intermountain instituted a multidisease care management program called 'Care Management Plus' relying on dedicated nurses in seven clinics. Their outcomes were compared to those in six control clinics. In the 1144 intervention patients versus the 2,288 control patients, mortality was lower at 1 year (6.2%, vs 10.6% for controls) and at 2 years (12.9% vs 18.2%). The hospitalization rate was lower (21.0%, vs. 24.2% for controls) at 1 year and substantially more so at the 2-year follow-up. Hypothesized savings from decreased hospitalizations was $17,384 to $70,349, but access to the abstract and not the full article doesn't allow the DMCB to compare the savings to the costs of the program. (Link)
Rosenthal, T. C., M. E. Horwitz, et al: Medicaid Primary Care Services in New York State: Partial Capitation vs Full Capitation. J Fam Practice 1996;42(4):362-368. According to a write up by the folks in the PCPCC, during the 1990s, Erie County in New York State implemented a primary care medical home program for dual eligible Medicaid-Medicare beneficiaries. The abstract itself says claims data was used by the New York State Department of Social Services to compare the costs for matched cohorts enrolled in partial capitation programs, in which the primary care physician is paid an ambulatory primary care monthly fee for its assigned Medicaid recipients. This partial capitation program worked as well as full capitation and saved the state 38% compared with a matched control group enrolled in traditional, fee-for-service settings. The PCPCC also says quality measures and patient satisfaction for partial and full capitation programs were equivalent and there were savings of $1 million for every 1000 enrollees (No Link Available at the Journal of Family Practice but a reproduced abstract is here).
Geriatric Resources for Assessment and Care of Elders (GRACE) Model - Counsell SR, Callahan CM, Clark DO, et al: Geriatric care management for low-income seniors: a randomized controlled trial. JAMA. 2007;12;298(22):2623-33. Researchers at the Indiana University Center for Aging Research and Regenstrief recruited medically indigent outpatients aged more than 65 years from six community-based health centers affiliated with Wishard Health Services, a university-affiliated urban health care system in Indianapolis, Indiana, between January 2002 and August 2004. Over 900 patients were randomly assigned to usual care versus the GRACE intervention. This involved an advanced practice nurse and social worker who worked in close collaboration with the primary care physician and a geriatrician-led geriatrics interdisciplinary team. The cumulative 2-year ED visit rate per 1000 was statistically significantly lower in the intervention group (1445 vs 1748), but hospital admission rates were not significantly different. However, in a predefined group at high risk of hospitalization (comprising 112 GRACE and 114 usual-care patients), ED visit and hospital admission rates were lower for the GRACE patients in the second year (848 vs. 1314 and 396 vs. 705, respectively). (Link)
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