Medical Homes and the VA

The medical home concept is an extension of the primary care physician role to emphasize having a single clinician be responsible for managing and coordinating a patient’s care.  The benefits are alleged to include both better quality and lower costs.  The Veteran’s Health Administration in 2010 started a program they called Patient Aligned Care Teams to implement a medical home at all VHA primary care clinics, an effort in which it invested $2 billion.  A study published in Health Affairs looked at the results from this initiative.   (HA Article)   The VHA clinics have over 5 million primary care patients a year.  Medical home models are not homogenous, the VHA’s focuses on creating a team led by a doctor or nurse practitioner, improving care coordination and emphasizing integration of mental health care.  Ironically in light of recent events, one feature was to increase access to same-day visits.  Guess that didn’t work out so well.  About 11 million patients at 908 primary care clinics were included in the analysis, which looked at outcomes before and after implementation of the medical home.  Hospitalizations for ambulatory care sensitive conditions and outpatient mental health visits decreased slightly, but statistically significantly, while primary care visits for patients over 65 increased significantly.  No other utilization categories, including hospitalizations or emergency room use, showed a significant change.  The authors estimated savings at $639 million.  The program had a net loss, given the expense incurred at startup, conceivably if the savings occurred annually or increased, the program would show a net financial benefit.  In fairness, the recent revelations about widespread delays in obtaining care could be a significant confounder in interpreting these results.