Results From Another Medical Home Initiative

Colorado piloted a multi-payer patient-centered medical home model and a recent analysis sponsored by the Commonwealth Fund looked at results from he first three years of the pilot.  (Commonwealth Summary)   The pilot involved 15 practices and covered about 100,000 patients.  The three-year evaluation was considered important because of a belief that it takes a while for practices to fully adopt the medical home model and for its benefits to be reflected.   Over this period there were some important gains.  Emergency room use went down by about 9.3%, or 1.6 visits per thousand member months.  This was up slightly from the end of the second year, indicating sustained and continuing improvement. The cost implications of less ER use amounted to $3.50 per member per month.  For patients with two or more illnesses, there was a 10% reduction in avoidable hospitalizations.  Somewhat surprisingly, there was a reduction in primary care visits or 4.2 per thousand member months.  Nothwithstanding the lower costs in some areas, overall spending on these patients was not reduced, indicating increases elsewhere, and I suspect that if the full costs to the physician practices has been included, there was a net spending increase.  I suspect this analysis is complicated by the continued growth in high-deductible plans.  Be useful to see a sub-analysis by benefit design.  Among quality measures there were mixed outcomes.  There was 3.3% increase in cervical cancer screenings, but a lower rate of colon cancer screening and of testing for blood sugar control in diabetes patients.  All-in-all, seems like a pretty negative outcome for this pilot, with very minor quality improvements and a net increase in health costs.