New Study Shows Patient Centered Medical Homes Improve Health, Lower Costs

(11.11.2015)
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Patient centered medical home (PCMH) practices can improve health outcomes and lower costs for patients, according to a new study by Blue Cross & Blue Shield of Rhode Island (BCBSRI). At the end of a five-year study period, and in the final year of the study, PCMH practices were 5 percent less costly and saved $30M compared to standard primary care providers.

A recent analysis of BCBSRI’s PCMH experience between 2009-2014 found patients with complex medical conditions, like diabetes or cardiac health issues, are 16 percent less likely to be hospitalized or need to visit an emergency department, and readmissions to hospitals were 30 percent lower, compared to someone seeing a standard primary care provider. In addition, patients at PCMH practices saw marked improvements in a range of quality measures including diabetes care and colorectal screening. 

“We have invested heavily in provider partnerships committed to delivering on the triple aim of improving population health, patient experience and cost of care, and this study shows that we are beginning to see returns on that investment,” said Peter Andruszkiewicz, president and CEO of BCBSRI. “While we are pleased with the results to date, healthcare remains too expensive and does not produce the experience our members deserve. Blue Cross remains focused on accelerating delivery system change and achieving a simpler, more satisfying and affordable care experience for our members and all Rhode Islanders.”

The report tracked more than 89,000 commercial and 14,000 Medicare Advantage members within BCBSRI’s PCMH over the 2009 – 2014 time period. Today, BCBSRI has 137,000patients seen in PCMH practices.  Return on investment in the PCMH program was more than 250 percent, highlighting the value of focusing on enhanced access to team-based primary care and investing in programs that enable a coordinated care experience for those who need it most.

BCBSRI has a strategic plan to drive toward affordable and simple care for all members by 2018. The company will build on proven approaches like strong provider partnerships, embracing and facilitating collaboration, and promoting a team-based approach to care that puts patients at the center.

“Achieving this early success has required a complete shift in the way both BCBSRI and our provider partners think about financial incentives, and reinforces the importance of moving away from fee-for-service payments.  Instead of rewarding volume of care, BCBSRI and our partners have shared financial incentives to improve access to care, coordination among clinicians in different settings and, ultimately, the health of BCBSRI members,” said Mark Waggoner, senior vice president of care integration and management, BCBSRI.

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