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Physicians Treating Patients in PCMH’s Offered Enhanced Patient Care, Even during Early Transformation

October 2019 | Written by Winnie C. Chi, PhD, MS

Patient-centered medical homes (PCMH) are physician practices that use cross-disciplinary teams of professionals who put the patient at the center of the healthcare delivery system by focusing on improving outcomes while reducing costs associated with inconsistent, duplicate, or fragmented care. Typically, patient-centered medical home practices are open beyond traditional office hours and use technology to be more proactive in managing and communicating with their patients.

Most PCMH studies are limited to measuring whether patients have their cholesterol levels taken, receive their HbA1c testing, and reporting their values.

HealthCore went beyond these to measure whether patients with diabetes and cardiovascular disease had better health outcomes in a hallmark study comparing patient results based on PCMH status. This baseline study included a control group of commercially insured members in some practices in New York not treated by PCMH practices to draw more accurate comparisons. The study included 31,032 PCMH and 350,015 non-PCMH patients.

Specific findings:

  • Total medical costs in the PCMH adult population were $93 – or 15 percent – less per-member, per-month than in the non-PCMH adult population (risk-adjusted and including medical and pharmacy spending).
  • Healthcare costs to treat children were 8.6 percent – less per-member, per-month in the PCMH population (risk-adjusted and including medical and pharmacy spending).
  • A larger percentage of PCMH patients with cardiovascular disease received LDL-C screening.
  • Cardiovascular patients in the PCMH practices achieved better control of their LDL cholesterol (65 percent compared to 57 percent).
  • Fewer PCMH patients with lower-back pain received inappropriate imaging tests.
  • Children with pharyngitis in PCMH practices received more appropriate testing (97 percent compared to 91 percent).
  • Antibiotic use among children for non-bacterial conditions also was lower (27 percent compared to 35 percent).
  • PCMH-treated asthma patients had higher use of long-term controller medication.
  • Both PCMH-treated children and adults between 18 to 44 years old experienced significantly lower hospitalizations and emergency room visits.

Physicians treating patients in PCMHs were more likely to provide higher quality of care, foster better health outcomes at lower cost prior to receiving PCMH recognition from the National Committee for Quality Assurance (NCQA). These evidence support that the standards for PCMH recognition by NCQA are consistent with and help to promote high-quality, cost-effective care.

Another important implication of this study is that the transformational process leading up to PCMH recognition usually happens over a period of time, and potential benefits associated with the transformation also accrue over time.

Study results were originally reported in a press release on September 24, 2012.
Winnie C. Chi, PhD, MS
Director, Population Health, Translational Research

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