Reduced Acute Inpatient Care Was Largest Savings Component Of Geisinger Health System’s Patient-Centered Medical Home

Abstract

Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care.

Synthesis Of Research On Patient-Centered Medical Homes Brings Systematic Differences Into Relief

“…Additional time may be required to observe reductions in utilization achieved through enhanced care coordination and preventive care. 43 Our data also suggest that the impact of PCMHs may be most readily observable in populations most likely to benefit from well-coordinated care across multiple specialties and care settings— particularly patients with complex conditions. Whether this holds true for patients with more versus less complicated chronic conditions, or for patients with more complicated combinations of chronic conditions, should be explored further.…”

Team-based versus traditional primary care models and short-term outcomes after hospital discharge

“…In the US, many of the primary care practices studied thus far that undertook transformation for enhanced care coordination within the Patient-Centered Medical Home framework were found to have significantly lower readmission rates. [50][51][52][53][54] These often included case management, multidisciplinary teams and postdischarge follow-up. Of note, the Patient-Centered Medical Home model strongly emphasize care coordination across all elements of the health care system (e.g., hospitals, home health care, community resources and supports).…”

The Reduction in ED and Hospital Admissions in Medical Home Practices Is Specific to Primary Care–Sensitive Chronic Conditions

“…, ; Maeng et al. ). One recent moderate‐sized multipayer evaluation of NCQA‐certified PCMH implementation found only limited quality improvements and no improvement in cost of care, hospitalizations, or emergency department (ED) utilization (Friedberg et al.…”