Medical Home Evaluations

There isn’t much that CMS hasn’t tried to improve quality and lower costs in the Medicare and Medicaid programs, including the comprehensive primary care initiative, which is a medical home model.  The first annual evaluation of the initiative, performed by Mathematica, isn’t too encouraging.  (Mathematica Report)   CMS selected payor and provider partners in  seven regions of the country.  The practices were required to bolster capabilities in several functions believed to be key to improving care coordination and quality.  Most of the practices were judged to have successfully met these standards.  The non-CMS payers agreed with CMS to pay the practices extra fees for care management.  Most of the practices stayed in the initiative, but have few patients enrolled.  The early results suggest that any cost savings, in regard to the Medicare patients, did not cover the cost of the extra payments to the practices, and it is unclear that there was a clear control group of patients to which spending was being compared.  There was a significant reduction in unplanned hospital readmissions, but few other noticeable effects on quality.  As the researchers note, it is very early in this program, so there isn’t really enough information to draw clear conclusions.   And at some point the practices are going to have to perceive that all the extra work they have to do and the extra costs they incur to participate, result in more income to the providers.  We strongly suspect that, like most things related to the reform law, when you add up all the public and private administrative and other costs that are being incurred, it will be very hard to show net spending reductions.  If, however, there is a clear improvement in the quality of care provided to, and the health status of patients, then that may be a sufficient justification for the effort.