Medical homes are seen as a way to reinvent primary care and improve the quality, cost and patient experience. Since 2007, more than 5,700 medical practices have become NCQA-recognized PCMHs. Medical homes got an even bigger boost under the Affordable Care Act, which directed Medicare to fund several pilot programs to bolster primary care.
One such effort has Medicare paying 1,200 medical practices in eight states to provide health care in a PCMH to more 900,000 beneficiaries. Those federal government-funded pilots found to improve health care and lower costs can be rolled out nationwide through two of America's largest health care insurers, Medicare and Medicaid. Boosting the stock of PCMHs is part of Obamacare's effort to spur changes in how health care is paid for—away from costly, piecemeal payments to global or fixed payments that force providers to focus on quality and improved patient outcomes.
Because the number of PCMHs only really started increasing in 2010, the body of conclusive research on medical homes is lacking. They are shown to increase care quality, boost patient satisfaction and lower costs in integrated delivery systems like Group Health, where health plans, doctors and hospitals are jointly owned. But there are substantial costs involved in a PCMH. Group Health, for example, has 400,000 members in medical homes; they invested an additional $16 per patient per year in added staffing for its prototype, not counting sizable investments in information technology.
Whether they can do the same in stand-alone medical practices and other settings still is up for debate. Many insurers, doctors and even hospitals are betting that PCMHs will cut hospital-related costs and eventually lead to reduced illness via their focus on primary and preventive care. As most health insurers and payers roll out risk-based forms of payments to providers, even hospital systems are sponsoring PCMHs.
Brigham and Women's Hospital is one, sponsoring medical homes around Boston like its Advanced Primary Care Associates, South Huntington, in city's Jamaica Plain neighborhood. "I give Brigham and Women's a lot of credit," says clinic medical director Dr. Stuart Pollack. In the two years it's been open, preliminary results show that hospitalizations among the clinic's patients have dropped in half.
A hospital's bread and butter are patients in beds. But as payers in Massachusetts are holding hospitals and other providers accountable for patient outcomes, Brigham and Women's has given up doing business as usual. Many patients at the South Huntington branch lack transportation or must choose between paying for food or medication. "We have people working your housing issue and food issue," says Pollack. Care is set up for the convenience of the patient, not the provider. Instead of referring out those patients who need mental health care, the clinic has brought behavioral health professionals on site to ensure patients get the help they need, which can prevent costly trips to the emergency room or hospital.
Gone are bankers' hours, days- or even weeks-long waits to see the doctor, and playing phone tag to get test results. "We have same-day services for established patients," notes Pollack. The clinic closes to patients for two hours every Wednesday afternoon so clinic staff (all of whom are employed by the hospital) can do a "population huddle." One late August afternoon, the clinic's team ran patient registry data to find which diabetics lacked recent cholesterol and blood-sugar screenings. Doctors, nurses, pharmacists, and front-office staff contacted a dozen patients to wrangle them in.
One of the nation's biggest medical home rollouts is throughout bucolic Vermont, which has enlisted commercial, state and federal health care payers to support PCMHs so all Vermonters have access to a continuum of seamless, effective and preventive health services. In its fifth year, the state's Blueprint for Health finds most residents getting care in a PCMH (most of Vermont's primary care practices are PCMHs), which are aligned with hospitals and so-called community health teams. The teams, comprised of nurses, pharmacists, social workers, mental health professionals, health coaches and others, support primary care providers and their patients.