Primary care 'medical home' model catching on, slowly
The patient-centered medical home model is part of the ongoing trend toward coordinated care and faces many of the same challenges.
A new report shows that New York state has seen strong growth in a care model that is designed to improve quality and coordinate care services around a primary care “medical home.” However, the growth has been uneven across the state, and other than Medicaid funding, payer support has not been strong for the model.
According to a release by the United Hospital Fund (UHF), the number of primary care providers adopting the patient-centered medical home (PCMH) model of care rose by more than 35 percent between May 2017 and May 2018.
UHF analysis describes PCMH as “A patient-centric model of care that strengthens relationships between patients and their clinical teams, focusing on improving the health of the population served by the practice. It is especially valuable for treating people with multiple chronic conditions, who generate a disproportionate share of U.S. health care costs.”
Other industry groups have praised the model for both improved outcomes and cost savings. CareFirst, a Blue Cross plan with enrollees in Washington, D.C., Maryland, and Virginia, said in 2018 that PCMH programs had lowered the cost of care for patients by $1.2 billion over seven years.
Growth linked to Medicaid funding
The growth of PCMH in New York coincided with the state’s introduction of the Delivery System Reform Incentive Payment (DSRIP) program, which provided incentives for health systems to coordinate care.
“It appears that DSRIP accounted in large part for the sharp rise in PCMH clinicians from 2017 to 2018,” said Gregory Burke, director of Innovation Strategies at UHF. “The increased adoption of the medical home model moves us further toward achieving a higher-performing health care system overall.”
The UHF report noted that the number of clinicians working in PCMH practices has increased at an average rate of roughly 15 percent a year, from 3,400 clinicians in 2011 to more than 9,000 at the end of May 2018.
Adoption of model still uneven
In New York, growth of PCMH has been stronger in some areas than others. In particular, New York City has seen significantly slower adoption of the model.
The overall rate of adoption of PCMH in the state fits with an ongoing trend in the U.S. toward coordinated care. However, as with efforts in other states, getting multi-payer buy-in for models of care that have higher upfront costs has been problematic.
The report said payment reform is critical to sustaining the state’s adoption of PCMH. “Operating as a medical home requires new functions and staff that increase operating costs, which are not covered by traditional fee-for-service payments or by most emerging value-based payment arrangements,” the study said. “Few payers other than Medicaid support medical homes. This leaves many practices—particularly small independent primary care practices—unable to afford to switch to the PCMH model.”
In addition, other industry changes are creating challenges to the model’s continued growth—for example, convenient care practices such as retail clinics and urgent care clinics can work against the adoption of medical homes.
The UHF report said that a number of steps can be taken to improve the PCMH model, including expanding clinic hours; focusing on prevention and health education; helping patients negotiate the health system during and after acute episodes and hospitalization; and helping patients with multiple chronic diseases with management of their conditions.
“The continued growth of the PCMH model across the state has been impressive,” said UHF president Anthony Shih MD, MPH. “Sustaining the model requires innovative responses that take into consideration new trends in delivery and payment.”
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