Medical Homes Improve but Health Care Costs Remain the Same
Medical homes are primary care practices that were created to offer patients comprehensive, personalized and team-based medical care based on patient registries and health records. In a three-year pilot study, researchers from the non-profit group, RAND Corporation, reported that even after making improvements in the medical home model that reduced hospitalization rates and emergency department visits, medical costs still remained the same.
"The medical home has gained popularity as a new model of primary care, with the expectation that the approach will produce better and lower-cost health care," said Dr. Mark W. Friedberg, the study's lead author and a natural scientist at RAND Corp. "Our findings suggest that achieving all of these goals is a challenge."
For this study, the researchers examined the Southeastern Pennsylvania Chronic Care Initiative, which included 32 primary care practices and six health care plans. The multipayer medical home pilot, which included a series of regional homes, took place from 2008 to 2011. The team examined data on quality utilization and costs of care for around 120,000 patients. The researchers compared the participating practices to 29 practices that did not participate.
The researchers found that the pilot practices were successful in getting recognized as a medical home from the National Committee on Quality Assurance. These practices had improved rates for tracking kidney disease for diabetic patients, better overall quality of care and improved diabetes care.
The researchers did report that the medical homes did not improve upon measures that assess asthma care, cancer detection and control of diabetes. The pilot medical homes also did not lead to a reduction in medical care costs for the patients. The researchers believe that once more revisions are made, the ideal medical home could be achieved.
"It is possible that the pilot we evaluated had some, but not all of the ingredients necessary to produce broad improvements in quality and efficiency," Friedberg said. "Findings from this evaluation and others should help refine the medical home model."
The study was published in Journal of the American Medical Association.