The patient-centered medical home model has spread throughout the country as of late, riding on the promise of coordinated care and improved quality. And, according to a three-year study conducted by Philadelphia-based health insurer Independence Blue Cross, PCMHs do lead to significant reductions in medical costs for patients with chronic illnesses.
Most notably, the study shows diabetic PCMH patients had 21 percent lower total medical costs, driven by a 44 percent reduction in hospital costs.
IBC isn't the only payer that has achieved success in a PCMH program: Horizon Blue Cross Blue Shield of New Jersey also recently announced its program improved quality and reduced costs for participating members.
PCMHs are seen by many as the building blocks of accountable care organizations, as the medical homes try to achieve at the physician practice level what ACOs achieve as an entire medical group, hospital or health system. The PCMH model aims to increase patient access and satisfaction, improve quality of care delivered and lower costs for patients who seek care in a specific physician office.
IBC has supported PCMH transformation for its in-network primary care offices for five years, and the payer currently has about 300 medical homes in its network, or about 40 percent of all of its primary care practices.
"We hope to grow that even more now," says Don Liss, MD, vice president of medical management for IBC. "We embraced the patient-centered medical home as a way to improve care hoping that we'd be able to demonstrate better care and that avoiding complications would lead to lower costs. Actually seeing these outcomes born out…reinforces our convictions."
Payer support
Beyond studying the positive effects of the PCMH model, IBC has a variety of ways to support practices while they transform into medical homes. For instance, IBC offers a free software tool to its practices through the American College of Physicians that helps practices find ways to improve efficiency, Dr. Liss says.
The payer also supports PCMHs with data that drives care coordination. "We provide clinical information about our members receiving care in [the] offices so they know about services delivered by other doctors," he says. This helps prevent duplicative and unnecessary care and also allows physicians to see where their patients go for care.
In addition to software and data that aid PCMH transformation for current physicians, the insurer supports the PCMH physician leaders of the future through partnerships, according to Dr. Liss.
"We're working closely with some of the most respected teaching hospitals in the region to include their residency programs to train the next generation of medical home doctors," he explains. The PCMH-focused residency programs, like the one run through Crozer-Keystone Family Medical Residency in Springfield, Pa., trains physicians who can then provide guidance and experience to existing practices that are trying to become a medical home.
Components of success
While Dr. Liss is proud of the way IBC has supported PCMH formation, he says the credit for the medical homes' success lies elsewhere. "The primary care practices in our network that made the commitment to transform and worked diligently to improve the way they deliver care — [they] deserve the credit," he says. He notes four specific components of a successful PCMH transformation:
• Committed physician leadership
• Team-based organization
• Having staff work at the top of their license
• Increasing patients' access to care
PCMHs in the future
The impressive results shown in the Independence Blue Cross study are encouraging for the future of the coordinated care model and could help the model spread further throughout the nation. "As healthcare reform gives more people coverage, it will be increasingly important to have access to effective primary care and better coordination," Dr. Liss says. "We hope…other private and public payers will appreciate the virtues of the PCMH and support its expansion."