The medical home delivery model, while increasingly popular, for a long time lacked the data its supporters needed to prove their case that the concept could deliver on the promise of quality improvement and long-term savings.
More evidence piles up
Savings coming from reduced hospital care
There were only two studies early on they could point to: A 2007 report in Health Affairs showing how medical homes helped Danville, Pa.-based Geisinger Health System reduce hospital admissions by 20% and cut medical costs by 7%, and how, after an initial $10.2 million investment, savings of $244 million were recorded for North Carolina's Medicaid system in 2004.
Now the data is rolling in from other pilot projects, and it supports the idea that much of the savings from medical homes is coming from reduced hospital care. New examples of the quality-improving, cost-lowering effectiveness of the medical home model reported by the Patient-Centered Primary Care Collaborative include data from Seattle-based Group Health Cooperative. According to a May 2010 Health Affairs article, the system received $1.50 for every $1 it invested in implementing the medical home model it began piloting in 2006—thanks in part to savings from a 29% reduction in emergency department visits, 11% reduction in “ambulatory sensitive care” admissions, and 6% fewer hospitalizations overall.
The collaborative also reports how fewer emergency visits and hospitalizations lowered costs for children enrolled in Medicaid and the State Children's Health Insurance Program in Colorado. It reported that the median annual medical cost for children seeing physicians participating in the Colorado Department of Health Care Policy and Financing's medical home program was $785 compared with $1,000 for control patients. When looking specifically at Denver children with chronic conditions, the median costs were $2,275 for patients seeing medical home-affiliated doctors compared with $3,404 in the control group.
Recent findings on medical home savings were released Oct. 25 by Blue Cross and Blue Shield of South Carolina, which reported the 809 diabetic patients enrolled in the 22-site, 55-provider medical home pilot it developed with Summerville-based Palmetto Primary Care Physicians last year had 10.7% fewer hospitalizations, 36.3% fewer inpatient hospital days, and 32.2% fewer emergency visits.
Much more research is expected. On Oct. 7, the Agency for Healthcare Research and Quality awarded the Michigan State University College of Human Medicine a $1.2 million grant to study the results of medical home pilots launched in 2009 by two Buffalo, N.Y.-based health plans: Priority Health and Independent Health. The grant, funded by the federal stimulus law, will be used to analyze claims data from 2009 through 2011.
A similar, $596,000 grant was awarded in August to Bloomington, Minn.-based HealthPartners Research Foundation to work with state agencies on a two-year study to measure the quality of care diabetics and heart disease patients are receiving in clinics operating as medical homes and then investigate how high-performing clinics achieved their success.
“It appears, early on, to be a win for everyone,” said Clayton Harbeck, executive vice president for MedSynergies, a technology, revenue-management and management services consultancy, of medical home pilots. “Better dollars for the doctor, better dollars for the payer, and better outcomes for the patient—but fewer admits for the hospital.”
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