NEW YORK, NY (March 28, 2013) — An EmblemHealth project found evidence that practice redesign and embedded care management in general adult primary care practices using the Patient-Centered Medical Home (PCMH) model results in modest, but promising, reduction in Emergency Department (ED) visits and improved quality of care. The findings, reported in an independent study by University of Connecticut (UConn) researchers, were published online by the Journal of General Internal Medicine on March 2, 2013.
Led by Judith Fifield, Ph.D. at UConn, and supported by The Commonwealth Fund, "Quality and Efficiency in Small Practices Transitioning to Patient-Centered Medical Homes: A Randomized Trial," investigates changes in quality of care and efficiency of care associated with a supportive PCMH transition package compared to a practice attempting the transition alone.
In September 2012, the same UConn research team published the results of an independent study of the first randomized controlled trial of the EmblemHealth Patient-Centered Medical Home project. The study demonstrated that even small and solo primary care practices can transition successfully to full PCMH status when the practices are provided with support, including practice redesign, care managers, and a revised payment plan. However, less had been known about the associated quality and efficiency outcomes when practices transition to a Patient-Centered Medical Home.
This new study looked at quality and efficiency outcomes associated with a two-year transition to PCMHs among physicians in 18 intervention practices with 43 physicians, versus 14 control practices with 24 physicians, all from adult primary care practices.
"This study adds to the growing evidence that there is opportunity for improved quality and efficiency when practices transition to Patient-Centered Medical Homes," says Dr. Fifield.
Modeled on 2008 NCQA (National Committee for Quality Assurance) Physician Practice Connections-Patient-Centered Medical Homes (PPC-PCMH) guidelines, intervention practices received 18 months of tailored practice redesign support; two years of revised payments, including up to $2.50 per member, per month, for achieving quality targets; up to $2.50 per member, per month for PPC-PCMH recognition; and 18 months of embedded care management support. Controls received yearly participation payments.
Compared to control physicians, intervention physicians significantly improved two of 11 quality indicators: hypertensive blood pressure control over two years (23 percentage point improvement in the intervention group, versus a two percentage point increase in the control group) and breast cancer screening over three years (3.5 percentage point improvement in the control group, versus a 0.4 percentage point decrease in the control group.)
Compared to control physicians, intervention physicians significantly improved one of 10 efficiency indicators. The number of care episodes resulting in ED visits was reduced (0.7 percentage point reduction in the intervention physician group, versus a 0.5 percentage point increase in the control group) with 3.8 fewer ED visits per year, saving approximately $1,900 in ED costs per physician, per year. There were no significant costs savings on any of the pre-specified costs of care measures.
Success was measured using 11 clinical quality indicators from the 2009 Healthcare Effectiveness Data and Information Set (HEDIS®) process and health outcome measures derived from patient claims data; 10 efficiency indicators based on Thomson Reuter efficiency indexes and ED visit ratios; and a panel of costs of care measures.
"This rigorous evaluation of EmblemHealth's work by The University of Connecticut Health Center, with support from the Commonwealth Fund, demonstrates that when medical practices achieve Patient-Centered Medical Home status, they have better outcomes and the potential for lowered costs. These findings have long-term implications for the future of health care delivery," said William Gillespie, MD, Chief Medical Officer of EmblemHealth, and one of the study's authors.
In addition to lead author Dr. Judith Fifield, the study's authors from the University of Connecticut Health Center are: Deborah Dauser Forrest Ph.D., Joseph A. Burleson Ph.D., and Melanie Martin-Peele, M.A.
To read the complete article: A Randomized, Controlled Trial of Implementing the Patient-Centered Medical Home Model in Solo and Small Practices, click on bit.ly/Wz8ks1.
EmblemHealth, Inc. provides quality health care coverage and administrative services to approximately 3.4 million people. Groups and individuals can choose from a variety of PPO, EPO and HMO plans, as well as coverage for prescription drugs and dental and vision care. EmblemHealth offers a choice of networks, including quality doctors and other health care professionals throughout the region, leading acute care hospitals across the tristate area, and physicians and hospitals across all 50 states. For more information, visit www.emblemhealth.com.
About The University of Connecticut Health Center:
The University of Connecticut Health Center includes the schools of medicine and dental medicine, the UConn Medical Group, University Dentists, and John Dempsey Hospital. Home to Bioscience Connecticut, the Health Center pursues a mission of providing outstanding health care education in an environment of exemplary patient care, research and public service. More information about the UConn Health Center is available at www.uchc.edu.
About The Commonwealth Fund:
The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).