Medical Homes

The reform law basically amounts to throwing a bunch of darts against the health care cost wall and seeing if any of them stick.  One of those darts is the medical home.  An Agency for HealthCare Research and Quality draft report summarizes the evidence to date on the potential value of medical homes in improving health care delivery and reducing costs.  (AHRQ Report)    One difficulty in assessing the evidence is the relative newness of the approach, which has limited the opportunity for research, as well as its ambiguous form.  While there are some “definitions” of a medical home, in practice many different components and techniques are being used.  Research involving one form of a medical home may not clearly identify which component(s) are responsible for success or lack thereof, or be transferable to other forms of the concept.

The Agency used a common definition that a medical home includes team based care, sustained partnership, structural changes to care, enhanced access, coordinated and comprehensive care and a systematic approach to quality.   The theory of a patient-centered medical home has been developed over several decades, as part of a general emphasis on re-conceiving primary care, particularly for those with chronic illnesses.   A number of pilots and full implementations of versions of the PCMH have been underway.  The review consisted of a literature search to identify credible research results demonstrating improvement in patient and provider experience of care delivery, quality or cost impacts.  The researchers found only 26 completed studies, along with about 30 in process.

The research suggests that there is moderate evidence that the PCMH has a small positive effect on patient experience of care and small to moderate impacts on preventive care.  Staff experience was also improved to a small degree.  No significant effects were found on utilization or overall costs, but this is largely due to lack of evidence.   The authors suggest that ongoing and new studies will provide much better quality and greater evidence on these questions.  Given the likelihood of quality gains, the authors properly suggest that whether or not there are cost savings is less important, since better quality at the same cost creates more value.