Assessing the Impact of the Patient-Centered Medical Home

In this project, HealthPartners Research Foundation evaluated the economic and quality outcomes of long-term Patient-Centered Medical Home (PCMH) clinics in the HealthPartners Medical Group (HPMG) system. HPMG is a multispecialty group in the metropolitan region of Minneapolis and St. Paul, Minnesota, that includes approximately 700 physicians, 40 percent of whom practice primary care in 21 clinics throughout the region.

HPMG has been implementing elements of the PCMH concept since 2000, and in 2009 they were all recognized as functioning at PCMH level III as defined by the National Committee for Quality Assurance (NCQA). The central hypothesis of this study was that a clinic's level of PCMH is significantly associated with higher quality, increased patient satisfaction, and reduced resource use. The main objectives of the project were to:

• Determine the associations between PCMH measures and the quality and patient satisfaction with care provided by HPMG clinics.
• Determine medical resource use within HPMG clinics.
• Identify trends in quality, satisfaction, and resource use occurring within HPMG clinics.
• Determine whether any identified trends within HPMG clinics differ significantly from the general secular trend occurring across Minnesota-based medical groups.

The study found that while there was substantial variation among the clinics on a variety of satisfaction and quality measures as well as on the overall and component scores from the Physician Practice Connections-Readiness Survey (PPC-RS) measure of medical home-ness, there was no relationship between PPC-RS scores and either quality or satisfaction. While the same lack of association was found for utilization and cost for all patients, there were some significant associations for the subgroup of patients with multiple prescriptions, suggesting that complex patients with more co-morbidities would have cost benefit from care in a PCMH. For patients receiving more than 50 percent of all primary care from within one of the certified PCMH clinics, there was a reduction in the number of visits per year to both primary care and specialist providers, which was also associated with lower costs for those services.

Over a 3 to 5 year time period, the clinics achieved a 1 to 3 percent annual increase in patient satisfaction and a 1 to 4 percent annual increase in adherence to quality measures for diabetes, coronary artery disease, preventive services, and generic medication use. When compared to the average for other medical groups in the region, these increases were greater for only some of the measures, and in several instances they only allowed these clinics to catch up to the community average. For cost and utilization, higher PPC-RS scores for medical home-ness were associated with lower emergency room use in all years. However, overall resource use was lower only among complex patients receiving multiple prescriptions within those clinics with higher PPC scores.