PCMH’s Impact on Cost and Quality?

I am, as a rule, a big fan of the PCMH concept.  The process for recognition and the inability to get those outside your circle to participate – namely, specialists are other things entirely, of course.  Even with those caveats, PCMH remains perhaps the best opportunity for practices to develop the discipline and receive the guidance required to improve their clinical response.  That’s a formal way to say: I think PCMH improves the quality of pediatric practices and I’ve seen it with my own eyes.

As a result of our interest in PCMH, PCC recently joined PCPCC – yes, another acronym, this one for the “Patient-Centered Primary Care Collaborative.”  You may recognize their work from the lists and maps I’ve shared from time to time where they have researched the various programs available to those who are recognized.

In January, they released an awesome document, “Patient Centered Medical Home’s Impact on Cost and Quality.”  My executive summary is quick: PCMH appears to be saving money on the macro level.  PCPCC has assembled a great set of resources and studies, well references and cited supporting this conclusion.  Among the results (quoting them directly):

  • Peer-reviewed scholarly publications. Of the 10 peer-reviewed studies that examined whether the PCMH was associated with a reduction in costs, six reported reductions (60 percent). Of the 13 studies that investigated the association between the PCMH and unnecessary utilization, 12 found a reduction in one or more measure (92 percent).
  • State government reports (non peer-reviewed). All seven state government evaluations reported reductions in at least one cost metric (100 percent) and six reported improvement in one or more measurement of utilization (86 percent).
  • Industry reports (non peer-reviewed). Six of the seven industry publications reported reductions in at least one utilization metric (86 percent) and four reported reductions in one or more cost metric (57 percent).
  • Aggregated outcomes from the 28 peer-reviewed studies, state government program evaluations, and industry reports: 17 found improvements in cost; 24 found improvements in utilization; 11 found improvements in quality; 10 found improvements in access; 8 found improvements in satisfaction.

I am as cynical as anyone, so I often wonder at a the relevance of “review of studies.”  Were the studies well done?  Did they simply look at the same thing over and over? How relevant are they to pediatrics?  Etc.  I’ve provided examples of this work before, here they’ve gathered many more results.  I like that they are not reviewing old literature, but  only that published in the year ending approximately November 2014.The biggest savings appear to come from reduced hospitalizations…is anyone shocked to see that an effective cost shift from hospitals to primary care hasn’t caught on among the specialists?

If the real savings are a fraction of what is reported here, PCMH will stick around.

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