A new study reported in the Journal of the American Medical Association finds little benefit from another of the hot “innovations”, the medical home. (JAMA Article) A medical home is a primary care site which takes responsibility for coordinating and managing the health and health care use of a patient. The medical home analyzed for this research was the Pennsylvania Chronic Care Initiative, a statewide, multipayer pilot. Participating physician practices were supported by six health plans and three professional organizations and received significant technical and financial assistance. The 32 practices participating in the pilot were compared with 29 similar practices which did not participate. The outcomes were various HEDIS quality measures and hospitalizations, ER use and ambulatory visits.
All of the pilot practices achieved medical home certification by the third year of the intervention and they reported significant structural changes in the practices. The pilot medical homes also received average bonuses over the study period of $92,000 per physician. Despite this, the medical home pilot practices showed statistically significant better care compared to the non-participating clinics on only one quality measure relating to diabetes care. And they performed no better on rates of utilization or cost of care, and actually had a worse rate of ambulatory care sensitive hospitalizations in one year of the study. Although it might be that the pilot practices were already practicing high-quality, low-cost care or that the non-participating comparison ones also improved on their own during the study period, it is more likely that the medical home concept, like so many in health care, just isn’t going to create the kind of outcomes its advocates suggest. And this study did not even take into account the extra costs associated with the pilot, which contribute to higher health spending.