I recently read a report in the Kaiser Health News titled “Health Law Experiment Failed to Show Savings.” The Affordable Care Act created a “laboratory” within the Centers for Medicare and Medicaid Services (CMS) to fund projects which had one of two goals: maintaining quality while reducing costs or improving quality while not increasing costs.
The concept of the Patient Centered Medical Home (also known as Medical Home) is based upon better coordination of care for individuals who are:
- Medicare beneficiaries,
- Accessing care from multiple providers including specialists, and
- Being treated in multiple locations including hospitals and emergency rooms.
The concept of the Medical Home makes perfect sense and was a logical approach to pursue, particularly for patients with complex chronic diseases. So what happened?
One of the goals of the Medical Home project was to decrease hospitalizations and emergency room visits – two areas where healthcare is especially costly. The data from the project appears to show that just the opposite happened. Hospital admissions and emergency room visits rose in centers that were a part of the project as compared to centers which were not part of the project! How can this have happened?
The centers that participated primarily focused their attention on populations that were poor and had chronic disease. The use of case managers in some of the projects helped to coordinate care delivery resulting in patients accessing more healthcare services than they would have otherwise. In this way it is possible that the project identified patients who had immediate healthcare needs which had not been previously addressed. It is likely that this scenario contributed to the rise in demand for services and in the costs related to those services.
A report by the RAND Corp. on behalf of HHS which studied the project results has concluded that the Patient Centered Medical Home project will not achieve cost savings. Does this mean that the Patient Centered Medical Home and improvements in coordination of the delivery of healthcare services is a dead concept?
Some have pointed out that many of the centers included in the project were not certified as Medical Homes until late in the project and that they therefore did not have the infrastructure in place for a long enough time to actually be able to realize the advantages of such coordinated care. Dr. Marshall Chin, University of Chicago medical school professor who reviewed drafts of the RAND study is quoted as saying, “It would be a mistake to say we can conclude that the medical home model does not work,” in the Kaiser Health News report.
At VitalHealth Software we have consistently focused on the development of tools to better coordinate the care delivered to patients with chronic diseases. On the basis of this experience I believe that the Patient Centered Medical Home concept is a good one. Proving the value, to patients and society, is a challenging task – one that will require additional study based upon well thought out project models.
It seems clear that the complexity of the healthcare process and the amount of time it takes to actually change infrastructure and processes are two of the factors which have confounded the analysis of the Patient Centered Medical Home experiment. Hopefully additional studies of this promising concept will be done in the future taking into account these variables.
Dr. Lester Wold
Chief Medical Officer, VitalHealth Software