So, like other highly touted panaceas that have attempted to rein in runaway healthcare costs and address dubious quality only to fall far short, does the PCMH movement's hype far exceed its results?
Perhaps. In this limited sample size over three years, it appears so. But before we file the designation under "Bad Ideas," let's address what the report leaves out.
1. The sample size was too small.
Analyzing the cost and quality results from 120,000 people over three years is a big task, but perhaps it's not big enough. After all, this report analyzed only a small piece of the PCMH-designated universe in a very limited geographic area.
Other studies have come to strikingly different conclusions. This report by the Patient-Centered Primary Care Collaborative, admittedly an advocacy organization, cites several PCMH initiatives that have gone on for much longer than three years, and that have saved significant sums (see page 9) in costs, and have had marked positive effects on utilization, quality and outcomes.
Health plans and the government are big believers, and since they pay the freight of healthcare services, there's no sign they are doing anything but increasing their investment in the PCMH structure.
2. Certification is only one of the first steps.
The fact is that Patient-Centered Medical Home certification is far from a guarantee that an organization is taking the necessary steps to both improve quality and cut healthcare spending. What it does do is assure that they have the tools to better coordinate care, and that staff at a particular practice have been trained to serve as the center of care for their patients.