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Patient-centered medical homes show early adoption success, but barriers remain

Insurers, skeptics hesitant to participate in experimental phases

Between 2009 and 2013, patient-centered medical homes (PCMHs) supported by payment incentives not only increased in number--from 26 to 114--but also in patients served, from 5 million to 21 million, according to a recent report from the Patient-Centered Primary Care Collaborative (PCPCC).

The report, which looked at seven state reports, seven insurance reports and 14 peer-reviewed studies, examined two big experiments run by the Center for Medicare & Medicaid Innovation (CMMI): a four-year program called the Comprehensive Primary Care (CPC) Initiative and a three-year test called the Multi-Payer Advanced Primary Care Practice Demonstration.

The CPC initiative was found to cut costs by $168 per Medicare beneficiary from the time CMMI established CPC in October 2012 to December 2013, noted a report from the Mathematica Policy Research.

Additionally, other payers who participated in the experiments, including state Medicaid programs and commercial insurers, generated $70,045 per clinician for a median practice for about 500 primary practices, reported Healthcare Payer News.

"It is especially promising to see savings from reduced emergency department, hospitalization and readmission rates so soon," the National Committee for Quality Assurance said in a prepared announcement, according to HCPN. Getting medical homes to their full potential "will likely require a longer commitment to the principles of coordinated care."

One barrier to greater commitment is the number of insurers in a specific market, according to the American Academy of Family Physicians. When PCMHs are first introduced, insurers are hesitant to engage because they are unaware of their value, the AAFP said.

Skeptics have voiced their concerns about CMMI in the past. Some wonder that, despite funding, the experiments do not have the necessary resources to perform sufficiently, FierceHealthPayer previously reported.

However, "despite early and sometimes mixed findings, the evidence here suggests that trends continue to be positive for practices that are able to fully implement the PCMH model of care," the PCPCC's authors wrote. "As highlighted previously, the longer a PCMH practice has implemented the model, the more impressive the results."

For more:
- here's the PCPCC report (.pdf)
- here's the Mathematica report (.pdf)
- read the Healthcare Payer News story
- check out the AAFP piece

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