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PCMH falls flat in New Orleans

Study shows no real gains in cost-cutting, access, or preventative care with PCMH

With the expansion of Medicaid provided by the Affordable Care Act, should be analyzed for their potential positive impact on Medicaid populations. A PCMH is a team-based health care delivery model led by a primary care physician that emphasizes specific elements of quality care.

Though prior researchers found that the adoption of more PCMH characteristics was associated with higher patient ratings of care coordination, it was not associated with improvement in accessibility, quality, and safety.

Source: felixtsao (Flickr/CC)

Source: felixtsao (Flickr/CC)

A study in the journal Health Affairs measured the impact of PCMH on appropriate utilization of care and fewer acute care needs by Medicaid patients in safety-net clinics in the New Orleans Area, where a number of safety-net clinics became early adopters of the PCMH model after receiving federal government funding following Hurricane Katrina in 2005.

The study observed 27 PCMH clinics and 376 control clinics with at least 50 Medicaid patients. They found no significant associations with PCMH certification and inpatient admissions, ED visits, or ambulatory care-sensitive inpatient and ED use. However, the .

This study leaves us with many questions: What is the impact of PCMH for the full payer mix of patients treated at these safety-net clinics (not just Medicaid, but the uninsured patients) and that mix’s impact on resource distribution? With more uninsured patients at some clinics, perhaps the care coordination and other resource-heavy interventions do not allow for full implementation across the clinic’s patient population. Also, what specific principles of PCMH make the largest impact on primary care use and cost of care, as opposed to using the single maker of NCQA certification as the independent variable? As Medicaid expansion occurs, what access and education interventions should instead be deployed in order to assure appropriate utilization? Since there is positive evidence for community health worker intervention and home visits programs, how can we incorporate this into the PCMH model?

Perhaps PCMH is a springboard that provides clinics with the infrastructure to address such opportunities.

commentary by Kameron Matthews, MD, JD

Abstract

The patient-centered medical home model of primary care has received considerable attention for its potential to improve outcomes and reduce health care costs. Yet little information exists about the model’s ability to achieve these goals for Medicaid patients. We sought to evaluate the effect of patient-centered medical home certification of Louisiana primary care clinics on the quality and cost of care over time for a Medicaid population. We used a quasi-experimental pre-post design with a matched control group to assess the effect of medical home certification on outcomes. We found no impact on acute care use and modest support for reduced costs and primary care use among medical homes serving higher proportions of chronically ill patients. These findings provide preliminary results related to the ability of the patient-centered medical home model to improve outcomes for Medicaid beneficiaries. The findings support a case-mix-adjusted payment policy for medical homes going forward. PMID: 25561648

Coles, ES, et al. Health Affairs. 2015; 34 (1): 87-94.

Kameron Matthews, MD, JD, FAAFP
About Kameron Matthews, MD, JD, FAAFP

Lead Analyst – Access to Care Kameron Matthews MD, JD is a board-certified family physician and currently serves as Deputy Executive Director of Provider Relations and Services in the Office of Community Care at the Veterans Health Administration in Washington, DC. She earned her medical degree from Johns Hopkins University and her law degree from the University of Chicago. Contact: Facebook | Twitter | More Posts