We haven’t addressed medical homes in a while, probably because the initial hype has largely passed and because ACOs have picked up much of the fervor. A multitude of pilots and initiatives using medical homes have been implemented both in private health insurance and in Medicaid programs. A study published in Health Affairs evaluates one such initiative: Louisiana’s promotion of medical homes. (HA Article) The patient-centered medical home is a model of intensive primary care with a large number of “standards” which a practice needs to meet to become recognized as a medical home. Supposedly the enhanced care coordination and attention to evidence-based medicine would both reduce costs and improve quality outcomes. Most evaluations to date have shown very limited, if any, progress on these goals. For state Medicaid programs, particularly those expanding eligibility under the reform law, finding some way to control spending is going to be crucial. The researchers used data from 2007 to 2010 from NCQA-certified medical home clinics in the New Orleans area and compared that data to information from similar clinics that weren’t medical homes. The researchers attempted to match medical homes and control clinics on various demographic and other factors. Surprisingly, primary care use was actually lower in the medical home clinics, which is counter-intuitive to the idea that in a medical home more primary care attention will occur. Emergency room use was also higher in the medical home clinic population, which again is contrary to what is supposed to happen. And ambulatory care-sensitive inpatient use was higher in the medical home group. Overall significant cost savings were not achieved, although in the later years it appears that the medical homes may have lower total costs per patient. Oh geez, another well-intentioned initiative just doesn’t seem to live up to the hype. Nonetheless, we suspect that models that are really capable of intensive focus on a patient’s medical needs will lower overall health spending at some point, and maybe will even save more than it costs to operate that intensive focus model.
Medical Homes and Medicaid
By Kevin RocheJanuary 30, 2015Commentary
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
Another example of over-priced companies trying to find some way to survive in the post-epidemic financial world. Transcarent, which does something, somehow to “access high quality, affordable care” is buying...
March 6, 2023
In an attempt to swiftly revive two floundering health care companies, a PE firm has announced the merger and recapitalization of Revive Health and SwiftMD. You know they are...
January 30, 2023
Investors have not yet learned their lesson, as Pearl Health gathers a new round of $75 million in capital for its business of supporting physicians who want to participate in...
January 30, 2023
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace
March 21, 2023
Minnesota’s New Energy Insanity, Part 7
Minnesota is a particularly poor place to rely on solar power, but other states aren't…
March 21, 2023
A Quick SVB Follow-up
As I suspected, the SVB saga is primarily one of regulatory malfeasance, coupled with political…
March 19, 2023
Tom Frieden Speaks in the WSJ
A public health expert writes an article for the WSJ which amply demonstrates why Americans…