June 30, 2017

The medical home model improved access to care—but didn't save money, study finds

Daily Briefing

Implementing patient-centered medical homes in federally qualified health centers resulted in improved access to care, but failed to reduce use of medical services and health care expenditures in the short-term, according to a study published last week in the New England Journal of Medicine.

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Study details

For the study, researchers from RAND sought to examine the effects of financial and technical assistance on the implementation of patient-centered medical homes in federally qualified health centers. The researchers looked at whether CMS' Federally Qualified Health Center Advanced Primary Care Practice Demonstration, which lasted from November 2011 through November 2014, affected Medicare beneficiaries' experiences and use of services, as well as:

  • Health centers' status of medical-home recognition;
  • Medicare expenditures; and
  • Quality of care.

The researchers looked at data from Medicare, the National Committee for Quality Assurance, and the Health Resources and Services Administration to compare health outcomes at the 503 federally qualified health centers that participated in the demonstration with outcomes at 827 federally qualified health centers that did not participate in the demonstration.

Findings

The researchers found that 70 percent of health centers that participated in the demonstration achieved the highest level, level 3, of patient-centered medical home recognition from the National Committee for Quality Assurance within three years, compared with 11 percent of health centers that were not enrolled in the demonstration.

However, recognition as a level 3 medical home did not lead to reductions in use of medical services or Medicare expenditures among the health centers that participated in the demonstration, the researchers found. Instead, the researchers found health centers that participated in the demonstration experienced relatively larger increases in rates of emergency department visits, inpatient admissions, and Medicare Part B expenditures when compared with health centers that did not participate.

According to the researchers, "The demonstration was associated with few significant effects on beneficiary-reported outcomes." For instance, the researchers found that beneficiaries treated at health centers that participated in the demonstration reported improvements in receiving answers to medical questions within a day's time and being able to schedule an appointment as soon as needed when compared with centers that did not participate. However, the researchers wrote, "There were no significant between-group differences with respect to other scale scores for beneficiary experiences, evidence-based care, or health status."

Comments

Justin Timbie, the study's lead author and a senior health policy researcher at RAND, said improvements in access to care likely contributed to the rise in Medicare expenditures. "The demonstration sites had more primary-care visits and that is a good thing ... but the sites didn't reduce spending," he said.

Timbie added that "low-income populations generally have difficulty getting access to care." He explained, "The population has high levels of social risk factors so it's not easy for health center patients to routinely seek care for prevention in primary care" (Castellucci, Modern Healthcare, 6/23; Rappleye, Becker's CFO Report, 6/27; Timbie et al., New England Journal of Medicine, 6/21).

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