There is a very good article in the October 2014 issue of Health Affairs entitled, “Patient-Centered Medical Home Initiatives Expanded in 2009-13: Providers, Patients, And Payment Incentives Increased.”
“…patient-centered medical homes typically use multidisciplinary teams and advanced tools such as enhanced information technology, chronic disease registries, and online patient portals to proactively manage the full spectrum of patients’ needs. These primary care practices also feature an explicit focus on managing care transitions, often using dedicated care managers, and they frequently integrate behavioral health care into primary care.”
Sounds pretty good. It gets better. The authors also state:
“[The patient-centered medical home] is based on the fundamental tenets of primary care, including comprehensive care for the majority of health problems; long-term, person-focused care; serving as the first contact for new issues; and coordinated care.”
Awesome–sign me up!
The authors conducted a survey of patient-centered medical homes nationally and found the following:
- The number of these programs increased from 26 to 114 from 2009 to 2013.
- The number of patients cared for by these programs increased from 5M to 21M in the same time period.
- In a review of the literature, outcomes on cost and quality are mixed—indicating that (as expected) the patient-centered medical home is not a ‘silver bullet’ in healthcare, but still has implications for providing higher-quality, lower-cost care.
- Payment models for these programs were largely fee-for-service with some additional payments based on (1) pay-for-performance, (2) a fixed per-member-per-month dollar amount (on average $4 PMPM) or (3) a shared-savings model (i.e. if the overall cost of care for a panel of patients was lower than a ‘control group’ of patients, then the doctors would be paid a portion of the cost savings).
My own commentary on this article is that there may be higher-quality and lower-cost care the more the doctor reimbursement is based on pay-for-performance and shared-savings. The fact that the majority of reimbursement is still in the form of fee-for-service may be ‘getting in the way.’
After all, you get what you pay for.
If you pay for service (i.e. fee-for-service), you get service.
If you pay for performance, you get performance.
If you pay for savings, you get savings.
As Charlie Munger, Vice Chairman of Berkshire Hathaway says, “Incentives are Superpowers.”
However, these comments are supposition on my part, so it will be interesting to see what future studies show.
What does this mean for employee benefits professionals and healthcare consumers?
- Patient-centered medical homes have mixed results, but regardless they are growing.
- If you want to incorporate them as part of your employee benefits strategy, they are now more available to steer plan members to. However, they still are only involved with <10% of the US population—so there may not be one near you and your employees.
- If I could sum it up in two words, I would write, “It’s early.”
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