American Journal of Managed Care Study Demonstrates Better Health Outcomes, Lower Costs in PCMH Practices

HealthCore-conducted study compares patients results based on PCMH status

Study Demonstrates Better Health Outcomes, Lower Costs in PCMH Practices

<0> for HealthCore Inc.Lori McLaughlin, 317.407.7403orBrandon Davis, 804.366.3007 </0>

Physicians working in patient-centered medical homes in New York City and surrounding suburbs better managed their patients’ diseases, ordered fewer high-cost imaging tests, reduced patient emergency room visits and hospitalizations, and reduced costs of care for patients overall, according to a new study published in the Sept. 24 edition of the .

The study, conducted by HealthCore Inc., an independent subsidiary of WellPoint Inc., is unique in that the baseline study includes a control group of commercially insured members in WellPoint-affiliated plans in some practices in New York not treated by PCMH practices to draw more accurate comparisons.

“WellPoint was adamant that a study of its PCMH pilots should go beyond just measuring whether patients were having their cholesterol levels taken, receiving their HbA1c testing and reporting their values, and actually measure whether patients with diabetes and cardiovascular disease had better health outcomes,” said Jill Hummel, WellPoint vice president of payment innovation.

The comprehensive study incorporated Healthcare Effectiveness and Data Information Set measures, utilization and laboratory data, in combination with outcomes and cost data—making it a hallmark study in PCMH research.

“We were pleased to find that not only were health outcomes much stronger in PCMH practices, but that they also had lower costs in the early stages of their development into a full-fledged PCMH practice,” Hummel said.

Total medical costs in the PCMH adult population were $93 – or 15 percent – less per-member, per-month than in the non-PCMH adult population. Health care costs to treat children were also less in the PCMH population by 8.6 percent. The numbers are risk-adjusted and include medical and pharmacy spending.

Patient-centered medical homes are physician practices that use cross-disciplinary teams of professionals who put the patient at the center of the health care delivery system by focusing on improving outcomes while reducing costs associated with inconsistent, duplicate or fragmented care. Typically, patient-centered medical home practices are open beyond traditional office hours and use technology to be more proactive in managing and communicating with their patients.

“I describe my practice as a Norman Rockwell practice that follows an old-fashioned approach in taking care of people, which is basically holistic medicine,” said Dr. Salvatore Volpe, whose practice in Staten Island, New York, was the first solo practice nationally to receive the highest level of PCMH recognition from the National Committee for Quality Assurance in 2012. “If you can understand the patient in a continuum and not a 15-20 minute encounter, you’re more likely to make a difference in their lives.”

The patient-centered medical homes in this study, including Volpe’s practice, were in the process of receiving their NCQA recognition, which they all achieved by 2010, while the measurement period for the study took place during the entire year of 2009.

The study evaluated prevention and care for chronic conditions, including laboratory tests for HbA1c and cholesterol (LDL-C screening), eye examinations, medical attention for nephropathy in patients with diabetes, imaging procedures for low-back pain not supported by appropriate diagnoses and appropriate testing for children with pharyngitis.

Other assessments included: appropriate medication use, including antibiotic use in children with viral upper-respiratory infections and adults with acute bronchitis and the use of long-term controller medications among patients with persistent asthma. The study also evaluated the rates of inpatient hospitalizations and emergency department services and costs for PCMH and non-PCMH patients.

“While there were a few measures that showed non-PCMH patients faring slightly better, overwhelmingly those patients treated in PCMH practices were screened at higher rates, received more appropriate treatment and had fewer hospital and emergency room visits,” said Andrea DeVries, HealthCore director of research operations.

Specifically, the study found:

The study compared commercially insured patients treated by physician practices located in five boroughs of New York City and its suburbs in Nassau County, Suffolk County and Westchester County that were part of selected WellPoint affiliated health plans’ provider networks. The study included 31,032 PCMH and 350,015 non-PCMH patients.

Study authors include Andrea DeVries, PhD, Chia-husan Winnie Li, MS, Gayathri Sridhar, PhD of HealthCore, Jill Hummel, Scott Breidbart, MD, of WellPoint and John Barron, PharmD, of HealthCore.

HealthCore, based in Wilmington, Del., is the clinical outcomes research subsidiary of WellPoint, Inc. HealthCore has a team of highly experienced researchers including physicians, biostatisticians, pharmacists, epidemiologists, health economists and other scientists who study the “real world” safety and effectiveness of drugs, medical devices and care management interventions. HealthCore offers insight on how to best use this data and communicates these findings to health care decision-makers to support evidence-based medicine, product development decisions, safety monitoring, coverage decisions, process improvement and overall cost-effective health care. For more information, go to .