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Payers embrace medical homes 'with enthusiasm' to cut costs, improve care


Patient-centered medical homes (PCMH) have reached a critical juncture in their short existence--achieving broad private- and public-sector support while lowering costs, improving care and bettering health outcomes, according to a new report from the Patient-Centered Primary Care Collaborative (PCPCC).

What's more, investments that insurers and providers are making to fund these medical homes have offered both short- and long-term savings, leading the report authors to predict a continued uptick in medical home adoption. "Major health plans and industry partners are embracing the PCMH model with enthusiasm by creating insurance plans and developing tools and resources contributing to the implementation of medical homes," the report found.

Success achieved from the almost 36 PCMHs operating throughout the country provide "clear, convincing and compelling" evidence that PCMHs provide "better care, better quality and lower costs," PCPCC Executive Director Marci Nielsen said during a press briefing, according to AAFP News Now.

The PCMH model already has received support from more than 90 commercial insurance plans, including WellPoint, Aetna, Humana, UnitedHealth and Blue Cross Blue Shield plans. In fact, WellPoint has predicted its PCMH program could reduce medical costs by up to 20 percent in 2015, and UnitedHealth believes its PCMH-related efforts will save twice as much as they cost.

The Blue Cross Blue Shield Association's (BCBSA) plans are experimenting with different PCMH models in 47 states and the District of Columbia with more than 4 million participating members. "What we're seeing in the results is tremendous," Justine Handelman, vice president of legislative and regulatory policy at BCBSA, told CQ HealthBeat.

One such PCMH project sponsored by Blue Cross Blue Shield of North Dakota resulted in a 24 percent decrease in emergency visits and an 18 percent drop in inpatient hospital admission rates compared to the general population. "If you can do things in North Dakota, you can do them anywhere," Handelman said.

To learn more:
- read the PCPCC report
- see the AAFP News Now article
- check out the CQ HealthBeat article

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