Medical home program in Penn. improves quality of care after 3 years

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 - Medical Home

After three years, physician practices participating in a medical home pilot program in Pennsylvania showed improvements in the quality of care they delivered. Patients in the program also were less likely to visit the hospital and emergency department or see an ambulatory specialist.

Mark W. Friedberg, MD, MPP, of the RAND Corporation in Boston, and colleagues published their findings online in JAMA Internal Medicine on June 1.

They evaluated the northeast region of the Pennsylvania Chronic Care Initiative, which began in October in 2009 and included two commercial health plans and 29 primary care practices that were selected by the state after volunteering to participate. They also analyzed 29 similar practices in northeast Pennsylvania as a comparison group.

By month 18 of the 36-month program, practices were required to obtain recognition from the National Committee for Quality Assurance (NCQA) as a medical home. They also received $1.50 per patient per month in care management payments to pay for care manager salaries and an additional $1.50 per patient per month for practice support payments. They also could earn shared savings bonuses if they met certain quality metrics and if they spent below a certain threshold.

Friedberg et al developed and sent a survey to a leader in each practice in September 2010 and asked about their use of disease management, registries and EHRs. They sent a second survey in October 2012.

The two health plans provided the researchers with medical claims and enrollment data from Oct. 1, 2007 to Sept. 30, 2012. They included any patient who filed a claim for any medical reason.

All 29 of the practices earned NCQA recognition as a medical home. Researchers found that the practices had statistically significant higher performance in diabetes care quality and breast cancer screening, but there was no improvement in screening for colorectal cancer.

By the third year, participants in the program had significantly lower rates of all-cause hospitalization, all-cause emergency department visits, ambulatory care-sensitive emergency department visits and ambulatory visits to specialists. They also had higher rates of ambulatory primary care visits.