Medical home model improves care, but not costs among safety-net providers

The patient-centered medical home concept may face specific, significant challenges when implemented by safety-net providers, according to a study from nonprofit research organization RAND Corp., published by NEJM.

Researchers studied the 500 federally qualified health centers that received CMS funds and technical assistance from 2011-14 to implement the medical home model. They found these safety-net providers were successful in improving access to care, but were unable to reduce the use of specialty care, acute care or Medicare expenditures over the time period studied.

However, the researchers do not believe this is a failure of the medical home model. Rather, they suggest unique challenges face safety-net providers that indicate additional assistance is necessary, or more time is required to make an impact on costs and utilization. This is because FQHCs, which must provide care regardless of a patient's ability to pay, often serve patient populations with significant unmet needs, including long-standing disease burdens and social service needs. When access to care is improved, more care will be used, according to the study authors.

"Primary care medical practices are rapidly adopting the patient-centered medical home model of care and one result may be that under-served patients use more services once it becomes easier to access care," Justin Timbie, PhD, lead author of the study and a senior health policy researcher at RAND Corp., said in a statement. "There also is evidence that improvements in primary care may lead to reductions in specialty care and cost over a longer period than we examined in this study."

The researchers found 70 percent of the FQHCs receiving assistance through the CMS medical home demonstration were able to achieve the highest level of medical home recognition within three years. This was significantly greater than the FQHCs that did not receive CMS assistance (11 percent). Researchers also noted greater levels of patient access at safety-net sites that had CMS assistance. However, these sites experienced bigger increases in emergency room visits, inpatient admissions and spending on physician services, according to the study.

This indicates the increased access may have stimulated increased utilization. The authors called for more research into alternative designs of the medical home model for safety-net providers.


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