The Patient Centered Primary Care Collaborative is a major coalition which educates and advocates on medical home issues. It recently released an updated brief summarizing research regarding the cost and health outcomes of various medical home pilots and efforts around the country. (PCMH Brief) The projects reviewed include those in integrated delivery systems such as Kaiser and Geisinger, as well as those sponsored by private health plans and by Medicaid programs. The review covered some long-standing efforts to redefine primary care, particularly for the elderly, such as the Johns Hopkins Guided Care program and the GRACE pilot.
Most of these efforts showed consistent cost reduction, although it is hard to tell how rigorous the methodology is, and it does not often appear that there is randomization or matched cohorts. Examples include Geisinger’s 18% reduction in hospital admissions and 7% reduction in total per member per month costs; HealthPartners’ 39% decrease in emergency room visits and 24% decrease in hospital admissions over a five-year period; and Blue Cross Blue Shield of South Carolina’s 36% reduction in inpatient days and 6.5% lower pmpm costs. Most of the programs also had better outcomes measured by mortality rates, for example, or compliance with good care guidelines. Patient satisfaction also tended to be higher.
Few of the programs calculated a return on investment, but for those that did, it was positive. Group Health of Puget Sound stated that their ROI was 1.5:1 and Geisinger has said that theirs is in the range of 2 to 1. Many of the organizations doing these projects are already innovative and have a relatively comprehensive health system, as well as more advanced technology such as EMRs. It is not clear that the same results will occur in widespread, smaller community practices, nor has it really been conclusively demonstrated that a full move to the PCMH model will save as much money as these projects suggest. But the consistency and continuity of care seems to show good improvement.