In late January, the Centers for Medicare and Medicaid Services (CMS) released the early results of two multi-year innovation projects focused on the creation of patient-centered medical homes (PCMHs).
Although PCMH models have been lauded as a way to achieve CMS’ triple aim —better quality patient care and improved health at a lower cost—little evidence currently backs up this claim. The latest reports show that PCMH interventions hold promise, but the jury is still out.
“I think, two to three years from now, we will be in a totally different position, in terms of a sound evidence base for policy,” says Mark Friedberg, MD, MPP, a practicing general internist and senior natural scientist for the RAND Corporation. “We know these very large CMS demonstrations are just starting to trickle in with year one results.”
Both the Comprehensive Primary Care (CPC) Initiative and the Multi-payer Advanced Primary Care Practice (MAPCP) are large, multi-year CMS demonstrations launched in 2012 and 2011, respectively, and the reports cover just their first 12 months. Although different in numerous ways, both projects aim to create better coordinated care that will in turn lower hospital admissions and ED visits, reduce duplications, enhance patient health through prevention, improve chronic disease management, and move away from a fee-for-service approach. They are just two of many experiments supported by the 10-year, $10 billion CMS Innovation Center.
In its first 12 months, the CPC focused on improving the care of high-risk patients in four states plus three separate regions of the U.S. It served 345,000 Medicare beneficiaries and roughly 2.5 million patients overall among nearly 500 primary care practices identified as likely to achieve meaningful results.
The evaluation, performed by policy research firm Mathematica, found that CPC cut hospital admissions by 2% and saw a 3% reduction in ED visits relative to similar practices not participating in the initiative, contributing to an overall $168 savings per Medicare beneficiary. It generated more than $70,000 in additional revenue per median practice clinician.1
However, the Department of Health and Human Services (HHS) paid practices $240 per patient to cover the costs of establishing the medical home, including hiring nurses, improving electronic health records, and setting up 24-hour call lines. Thus, the initiative failed to offset its costs. Even so, Mathematica called the findings “promising” and “more favorable” than expected for the first year of the initiative, though it advised caution in interpreting the findings at this stage.
The MAPCP involved primary care initiatives in eight states, encompassing 3,800 providers across 700 practices; it touched 400,000 Medicare beneficiaries in its first year (today, it serves practices in just six states). Private payers and Medicaid also took part, leading to an estimated savings of $4.2 million, according to the initiative’s evaluators, RTI International and The Urban Institute.2
The demonstration realized a reduction in fee-for-service Medicare growth in Vermont and Michigan, largely resulting from lower inpatient expenditures, but did little to reduce hospitalizations, readmissions, or ED visits. Data collection and utilization were recurring challenges.
Dr. Friedberg says these first reports are akin to seeing the first few ships of the armada break the horizon. Last year, he was first author of a Journal of the American Medical Association study of a three-year PCMH intervention in Pennsylvania, Southeastern Pennsylvania’s Chronic Care Initiative, which also showed mixed results.3 He currently is part of a team evaluating the CMS Federally Qualified Health Center Advanced Primary Care Practice Demonstration, which concluded last October.