Pennsylvania Medical Home Model Links Data, Quality, Savings

Performance improvements are attributed in part to tying physicians' performance bonuses to actionable patient data. But "not all medical home interventions are alike," one researcher notes.

A medical home model in Pennsylvania that provided timely and pertinent patient data to physicians and paid bonuses for the resulting improved care showed significant improvements over comparison practices, a RAND study shows.

The study analyzed data from 17,363 patients from 27 pilot and 29 comparison practices in the northeast region of the Pennsylvania Chronic Care Initiative from 2009–2012. The pilot practices were recognized by the National Committee for Quality Assurance as medical homes, but did not receive payment for the designation.

By year three, the pilot practices had achieved statistically significantly better changes in performance on four measures of diabetes care and breast cancer screening. In addition, as measured per 1,000 patients per month, the pilot practices saw:

• 1.7 fewer hospitalizations
• 4.7 fewer emergency department visits
• A 3.2% lower rate of ambulatory care-sensitive emergency department visits
• Specialty care visits declined by 17.3 visits per month

The results were published this week in JAMA Internal Medicine.

Mark W. Friedberg, MD, the study's lead author and a senior natural scientist at RAND, says a key component of the success for the northeast region pilot medical homes was tying the performance bonuses with actionable patient data.

"The health plans that were participating in the northeast region in this paper also gave timely data to the participating practices on whether their patients were going to see their partners at hospitals and which ones they were going to, and which patients were going," he says.

"That was not part of the intervention in the southeast region, nor in a lot of the other medical home interventions. That may have had something to do with the effect we saw. That can be just as important as financial incentives. It's one thing to give more incentives and another to help them achieve those incentives, and they did both here."

Friedberg says it's too early to determine if the northeast pilot could provide a standard roadmap for successful medical homes.

"It's hard to make that kind of a big statement based on just one study, but this suggests features of medical home interventions that others may want to replicate," he says.

"When you create a medical home initiative to produce changes in utilization of care it makes sense to both give providers an incentive to control utilization and also to give them the means and ability to control the utilization, not just in the primary care practice but also in hospitals and emergency departments and unless you know where your patients are at all times that is very hard to do."

Friedberg says it's important to remember that the medical home is an evolving model.

"We and other researchers are continuing to evaluate different medical home pilots with different ingredients and different settings," he says. "The next big task—and we aren't ready to do this study yet—is to put all of those evaluations together and start to look at the differences in the results and see what seems to be the ideal way to construct a medical home intervention."

"The big take-away here is that not all medical home interventions are alike," he says. "As with any new attempt to try to improve the healthcare system, the first few attempts out of the starting blocks will include some experiences that we can learn from to make them more effective later. We are starting to see the second generation of these interventions. It seems so far to be potentially more effective than the earliest iterations.