Medical Homes Improve Outcomes for Underserved

Healthcare finance and delivery policies are shifting from volume to value, placing the burden on physicians, hospitals,  and administrators to identify and implement models that improve quality while also reducing cost. New evidence supports expanding the (PCMH) to achieve better outcomes for patients in underserved communities.

A recent article published in Health Services Research found that community health centers (CHC) with PCMH recognition performed significantly better on 9 out of 16 quality performance metrics and had nearly twice the revenue than their non-PCMH accredited peers. The CHCs included in this study’s sample provide care to over 21 million Americans, demonstrating the positive impact of PCMH for a large segment of the population. This is promising news for the advancement of health equity as CHCs by definition serve the most vulnerable patients, including disproportionate numbers of minority, rural, and chronically ill individuals, regardless of income or insurance status. Policies that support expansion of PCMH accreditation among CHCs will help to reduce the health disparities prevalent within these populations. In addition, this study produced interesting findings related to health information technology. Although PCMH-accredited CHCs were more likely to report on quality measures through the electronic health record (EHR), EHR reporting was negatively associated with performance. This difference may be due to sampling bias introduced through reporting based on selected chart reviews versus universal data reported through the EHR. This nuanced analysis provides important context as quality reporting shifts from sampling of selected records to comprehensive reporting through EHR submission.

This study has major implications for Medicare’s Merit-Based Incentive Payment System (MIPS) and alternative payment models (APM), which include health equity, quality, and health IT components. The proposed rule would incentivize PCMH accreditation by satisfying the clinical practice improvement activity category for MIPS providers. However, the bar may be too high for PCMH-accredited entities to qualify as an APM, which automatically provides enhanced payment rates.

As physicians anxiously prepare for MIPS, policymakers should consider this new evidence when developing final regulations.

commentary by Megan Douglas

Abstract

INTRODUCTION. America’s community health centers (HCs) are uniquely poised to implement the patient-centered medical home (PCMH) model, as they are effective in providing comprehensive, accessible, and continuous primary care. This study aims to evaluate the relationship between PCMH recognition in HCs and clinical performance.

METHODS. Data for this study came from the 2012 Uniform Data System (UDS) as well as a survey of HCs’ PCMH recognition achievement. The dependent variables included all 16 measures of clinical performance collected through UDS. Control measures included HC patient, provider, and practice characteristics. Bivariate analyses and multiple logistic regressions were conducted to compare clinical performance between HCs with and without PCMH recognition.

FINDINGS. Health centers that receive PCMH recognition generally performed better on clinical measures than HCs without PCMH recognition. After controlling for HC patient, provider, and practice characteristics, HCs with PCMH recognition reported significantly better performance on asthma-related pharmacologic therapy, diabetes control, pap testing, prenatal care, and tobacco cessation intervention.

CONCLUSION. This study establishes a positive association between PCMH recognition and clinical performance in HCs. If borne out in future longitudinal studies, policy makers and practices should advance the PCMH model as a strategy to further enhance the quality of primary care. 

Shi L. et al. HSR. 2016 June 20; [Epub ahead of print]. PMID 27324440