Medical home interventions that feature shared savings agreements for primary care practices may improve care quality and reduce the utilization of medical services, according to a recent study published in JAMA Internal Medicine.
To measure if medical home interventions are associated with changes in quality and care utilization, researchers conducted a multiyear study of the Northeastern Pennsylvania Chronic Care Initiative, which began in 2009.
The initiative included interventions such as learning collaboratives, disease registries, practice coaching, payments to support care manager salaries and practice transformation and shared savings incentives. To participate, pilot practices had to attain recognition by the National Committee for Quality Assurance as medical homes.
The shared savings part of the initiative — which included bonuses of up to 50 percent of any savings generated, contingent on meeting quality targets — created direct financial incentives to contain the cost and utilization of care without compromising the quality of care.
The research team analyzed information about 17,363 patients from 27 pilot and 29 comparison practices in the northeast region of the Pennsylvania Chronic Care Initiative and compared the two groups on their performance on six quality measures for diabetes and preventive care, as well as the utilization of hospitals, emergency departments and ambulatory care.
Ultimately, all of the pilot practices received recognition as medical homes during the intervention.
Additionally, by the third year of the intervention, the pilot practices had significantly better performance on four process measures of diabetes care and breast cancer screening than the comparison practices. The pilot practices also had:
1. Lower rates of all-cause hospitalization than at comparison practices (8.5 versus 10.2 per 1,000 patients per month)
2. Lower rates of all-cause emergency department visits (29.5 versus 34.2 per 1,000 patients per month).
3. Lower rates of ambulatory care-sensitive emergency department visits (16.2 versus 19.4 per 1,000 patients per month)
4. Lower rates of ambulatory visits to specialists (104.9 versus 122.2 per 1,000 patients per month); and
5. Higher rates of ambulatory primary care visits (349.0 versus 271.5 per 1,000 patients per month).
"During a three-year period, this medical home intervention, which included shared savings for participating practices, was associated with relative improvements in quality, increased primary care utilization and lower use of emergency department, hospital and specialty care," wrote the study authors. "With further experimentation and evaluation, such interventions may continue to become more effective."
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