The Power of the Patient Centered Medical Home

Madison Agee

Intended to have a transformative impact on healthcare, the Patient Centered Medical Home (PCMH) is a model that stresses care coordination, accessibility, patient centrality, comprehensiveness, quality and communication within primary care. It emphasizes primary care physicians, putting them in director-type roles in which these doctors have greater responsibility for the outcomes of their patients’ care. Ideally, the PCMH model can lead to higher quality of care, better outcomes, reduced healthcare costs, and more positive experiences for both the patient and the primary care doctor.

The merits of the PCMH approach to healthcare have been much discussed and analyzed in recent years, in scholarly journals and traditional and online media. Recently, a new Washington Post/Kaiser Health News article was published that highlights the cost savings that Healthways partner CareFirst has realized since the implementation of its PCMH program in 2011. Additional data released by CareFirst suggests that CareFirst members under the care of participating PCMH physicians fare well when measured on key quality indicators.

CareFirst is one of the largest health insurers in the country, with 1.1 million members enrolled in its PCMH. Since the program began, CareFirst has seen the overall rate of increase in medical care spending for its members slow from an average of 7.5 percent per year, in the five years preceding the program’s launch, to 3.5 percent in 2013.

In addition, key quality indicators suggest positive impacts on CareFirst members who are under the care of PCMH primary care providers. When compared to members under the care of non-PCMH physicians, CareFirst members seeing PCMH providers had:

  • 6.4% fewer hospital admissions*
  • 11.1% fewer days in the hospital*
  • 8.1% fewer hospital readmissions for all causes*
  • 11.3% fewer outpatient health facility visits*

This new data released by CareFirst certainly adds to the argument that the PCMH model is one that the healthcare industry should continue to explore as a way to improve outcomes and lower costs.

*Per 1,000 CareFirst Members.