Meredith Rosenthal, professor of health economics and policy at the Harvard School of Public Health and the study's lead author, said the medical home model “is not a magic pill” and that advocates “continue to make statements that ignore reality.” Still, she said, the medical home “is the right way to practice even if it doesn't generate short-term savings.”
Despite those findings, it was announced July 8 that 20 more Rhode Island practices serving some 260,000 patients were joining the program. Also, one of the payer participants, Blue Cross and Blue Shield of Rhode Island, announced July 31 that it was entering into a similar program with University Medicine, a Providence-based multispecialty group that includes six medical home practices and Brown University Medical School physicians.
Experts say broader payer support is critical for medical homes to succeed and grow. “The No. 1 obstacle is paying for it because it truly requires new resources—it requires technology, it requires care coordination and, under the traditional fee-for-service model, they're not getting any money for that,” said Mary Witt, a senior vice president for the Camden Group consultancy in Los Angeles.
There still are many markets where insurers are hesitant to take the first step and start paying for medical home care-coordination services. “Just getting somebody to jump first is the trick,” Geisinger's Graf said.
Geisinger believes it has the evidence that medical homes produce significant cost savings and improved quality. The system, with the support of its own Geisinger Health Plan, piloted its medical home program—called ProvenHealth Navigator—in 2007 with 3,000 Medicare patients. Preliminary results included greater adherence to prescription regimens, increased use of generic drugs, fewer hospital admissions and less use of skilled-nursing facilities. Using a formula that combines quality measures, total costs, patient experience and professional experience ratings, Graf said there was a 4% improvement after one to two years, 7% improvement after three to four years and 10% improvement after five years. Also, he said that for every $1 Geisinger invested in its medical homes, it got $1.70 back.