Impact of a patient-centered medical home pilot on quality and costs: Lessons for implementation and dissemination

The patient-centered medical home (PCMH) is an approach to care delivery and payment aimed at better coordinating care and meeting the unique needs of patients through enhanced primary care. The goal of the PCMH is to improve quality and reduce costs by avoiding costly emergency room visits and readmissions, and providing more coordinated and evidence-based primary care, particularly for patients with chronic conditions. This study evaluates the New Hampshire Citizens Health Initiative Multi-Stakeholder Medical Home Pilot, a two and a half year PCMH pilot in nine family practice sites throughout New Hampshire. Four commercial payers participated in this pilot and contributed per member per month payments for the duration of the pilot. In the context of growing interest in the PCMH model, this study offers insight into how the PCMH can be adapted in different contexts, the lessons learned for implementing practice redesign, and the potential for the PCMH model to impact health care utilization, cost, and quality outcomes. Site visits were conducted at each of the nine pilot sites, and interviews with 83 participants were completed. Quantitative analyses of the impact of the PCMH on utilization, cost, and quality measures were conducted using the New Hampshire Comprehensive Health Care Information System multi-payer claims database. While all nine sites achieved Level 3 Recognition as a PCMH according to the National Committee for Quality Assurance (NCQA) 2008 guidelines, the specific components of the PCMH models varied across the pilot sites. The composition of teams, the task of care coordination, and the use of disease registries were identified as some of the most critical features of the PCMH, but also varied significantly from site to site. While the quantitative analyses are currently underway, the findings will explore the potential for the PCMH model to impact key utilization, cost, and quality measures such as ambulatory care sensitive hospital admissions, ambulatory care sensitive emergency department visits, 30 day readmissions, and total per member per month costs. In addition, the impact of the PCMH model on preventive and chronic condition quality measures such as immunization and cancer screenings as well as glucose control, blood pressure control, and nephropathy screening among patients with diabetes will also be assessed. These findings will contribute to the growing literature on PCMH models across the country and inform future delivery system transformation as it moves beyond the walls of primary care to coordinate across the broader health care system.