Do “Medical Home Models” Really Work?

A medical-home model is when a patient is assigned to a primary care provider.  That primary care provider acts as the patient’s “medical home” and is responsible for managing and coordinating that patient’s health care.

The idea behind the popular patient-centered medical home approach is for physician groups to actively coordinate a patient’s care in order to offset fragmented care and reduce costly ER visits.

How effective are medical-home models?  The Wall Street Journal relays the findings of a recent study conducted by RAND Corp:

But a study of one of the earliest and largest medical-home pilots found that after three years, patients’ health improved in only 1 of 11 measures. There was no change in hospital or emergency-room use, and no significant cost savings.

Other studies find slight improvements for patient outcomes under a medical-home model:

Some smaller studies have found that PCMHs, can reduce costs and improve care. The JAMA study is the most comprehensive to date. It focused on one of the nation’s earliest PCMH projects, in southeastern Pennsylvania, with 32 mostly small and medium-size primary-care practices and more than 64,000 patients, evaluating them annually from 2008 to 2011. 

But the study found that patient care improved on only one statistically significant measure—the number of diabetes patients monitored for kidney problems. They showed no significant improvements in blood-sugar or blood-pressure control, or total cost of care over three years. The pilot practices also showed no significant improvements compared with a control group of 29 primary-care practices in the region that didn’t adopt medical-home practices.

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