Community health centers improved care access in medical home model, but spending increased
Policymakers have touted the patient-centered medical home model as an opportunity to improve access to primary-care services while decreasing healthcare costs through the prevention of chronic diseases. But a new study shows the model has mixed results.
The study, published Friday by RAND Corp. researchers, found community health centers that achieved recognition as a medical home reported patients had better access to primary-care services, but Medicare spending rose.
"The demonstration sites had more primary-care visits and that is a good thing ... but the sites didn't reduce spending," said Justin Timbie, lead author of the study and senior health policy researcher at RAND.
Timbie and his colleagues analyzed the effect of patient outcomes and spending for federally qualified health centers that participated in the CMS' Advanced Primary Care Demonstration. The program, which lasted from 2011 to 2014, gave 503 community health centers the financial and technical support to transform their practices into patient-centered medical homes recognized by the National Committee for Quality Assurance.
In the medical home model, primary-care physicians lead a team of professionals—including nurse practitioners, physician assistants, pharmacists, health educators and medical assistants—who take responsibility for providing or facilitating comprehensive, coordinated and accessible care for a panel of patients, looking at the health of the individuals and of the whole group. Team members also work closely with patients to engage them in taking care of themselves.
The hope from advocates of the model is low-income, older patients will be healthier because they have better access to preventive services.
The RAND study compared Medicare patient data of the community health centers included in the program to 827 health centers who didn't participate. The study found that community health centers in the medical home model reported an increase in primary-care visits compared to those not participating.
That's a good sign that the medical home model increased access to primary-care services, Timbie said.
At the same time, medical home participants saw increased Medicare Part B spending, emergency room visits and inpatient visits compared to the health centers that didn't participate. Increased access to services likely contributed to the Medicare spending uptick, as people sought out care more often, Timbie said.
Patient populations at these health centers are tough to manage, contributing to the greater emergency room and inpatient visits, he said.
The study found that about 50% of Medicare patients examined were also eligible for Medicaid.
"Low-income populations generally have difficulty getting access to care," Timbie said. "The population has high levels of social risk factors so it's not easy for health center patients to routinely seek care for prevention in primary care."
Furthermore, the study also didn't find a significant difference in outcomes related to patient experience between community health centers that are part of the CMS initiative versus those that were not. Community health centers across the country have made an effort to improve patients' experience, making it difficult to improve their results even more, Timbie said.
Although 70% of the community health centers involved in the CMS program were recognized as patient-centered medical homes, most achieved that recognition near the end of the three-year pilot. As a result, Timbie and his co-authors weren't able to asses the full affect of the model for a long period.
"We don't think the story is closed here," he said.
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