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PCMH Pilot Not Associated with Cost Reductions, Study Shows

Cheryl Clark, for HealthLeaders Media, February 27, 2014

NCQA Responds
The questionable usefulness of NCQA certification or recognition, which Friedberg says requires "a major effort and extra time, even the process of submitting the NCQA application, to receive recognition," prompted a NCQA response.

The NCQA said the pilots in the Friedberg study were rated on "outdated" NCQA standards for patient-centered medical homes that have since been revised. The organization said Friedberg's report "contradicts several others that have shown improvements in cost, quality, access, and patient experience." That evidence is why "most states and many private and commercial insurers support PCMHs with financial or technical support."

The NCQA intends to give an additional update on its requirements with new standards in March.

In the Pennsylvania pilot, commercial payers and Medicaid health plans paid the physician practices in the pilot about $92,000 per practice in bonuses, which they could have used to expand or support personnel or technology in an effort to improve care to patients beyond the office visit. They also received traditional fee for service payments.

There was no payment incentive for keeping patients out of the hospital, or for avoiding emergency department visits for medical complaints that could have been handled in an outpatient setting. That may be the next thing to come.

An Anthropologist's View
Ben Crabtree, an anthropologist who has teamed up with physician researchers under a Robert Wood Johnson grant to evaluate pilot models of innovative practices including PCMHs, says physician practices need to be totally redesigned with a care coordinator who is part of the team in order to make the concept work.

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6 comments on "PCMH Pilot Not Associated with Cost Reductions, Study Shows"


Tia McClung (3/12/2014 at 9:16 AM)
A close evaluation of the article gleans that the research period of 2008-2011 is not reflective of the current model of PCMH that is accredited by NCQA. The Level 2 accreditation has a gross disparity to the Level 3 accreditation and practices that had the former recognition find that they truly lack the standards, best practices and the rigid benchmarks and outcomes that the latest accreditation requires. Level 2 provider groups that strive for accreditation within the current highest recognition can speak to the rigor and change that occurs with the Level 3 accreditation. Most likely, a pilot study with date ranges of 2011-2014 will provide some positive key messaging re: the value of the Patient Centered Medical Home.

Michele Bordelon (3/5/2014 at 3:31 PM)
Until PCMH's utilize a strong patient engagement piece (e.g. regular coaching for lifestyle change and wellness management) this will not change.

R Libby (3/3/2014 at 3:23 PM)
There are mountains of data supporting the impact of patient centered medical homes on decreasing cost and improving outcomes, looking at more diverse and significantly larger patient populations than cited in the JAMA article. The process of being certified as a patient centered medical home is nothing but an exercise in developing a small part of the process necessary to transform a primary care (and, hopefully, specialty) practice into one that is capable of managing population health. This does not happen over a 3 year period; it is a learning continuum that evolves as a patient care and business model. It needs the continuing support of payment innovations that help fund its infrastructure, and the collaboration of stakeholders to find more cost efficient alternatives to the current consumer oriented trends of retail health care services, the fee for service margin/volume inspired payment system, and the inflation in overall health care costs by so many of the uncontrollable settings patients may find themselves in. One would hope that the conclusions of the JAMA article were used as a learning tool that can help improve the process, not undermine it.