Patient-Centered Medical Homes Reduce Cost and Utilization

Patient-centered medical homes generally reduce both cost and utilization, according to a new report from the Patient-Centered Primary Care Collaborative.


The patient-centered medical home (PCMH) is an innovation in care delivery designed to advance and achieve the Triple Aim of improved patient experience, improved population health and reduced cost of care. A medical home provides enhanced primary care services of value to patients, their families and their care teams.


“By investing in enhanced primary care and ensuring PCMHs are foundational to Accountable Care Organizations (ACOs) and/or other integrated health systems, the PCMH model is demonstrating that a cost-effective, accessible, more equitable, higher-quality healthcare system is possible,” wrote the authors of the report.


The report from the Patient-Centered Primary Care Collaborative summarizes PCMH cost and utilization results from peer-reviewed studies, state government evaluations, industry reports and independent federal program evaluations published between October 2014 and November 2015. The research review includes long-awaited developments in health system payment reform including Medicare’s transition to value-based payments. The authors found evidence that PCMH programs provide long-term savings.


Review Findings


  • 21 of 23 studies that reported on cost measures found reductions in one or more measures


  • 23 of 25 studies that reported on utilization measures found reductions in one or more measures


  • The longer the PCMH program had been implemented and subsequently evaluated, improvements in cost or utilization were demonstrated


  • The PCMH initiatives with the most impressive cost and utilization outcomes were generally those that participated in multi-payer collaboratives with specific incentives or performance measures linked to quality, utilization, patient engagement and/or cost savings


Key Points from the Review


Controlling Costs by Right Sizing Care: Advanced primary care is foundational to delivery system transformation—medical home initiatives continue to reduce healthcare costs and unnecessary utilization of services.


Aligning Payment and Performance: Payment reform is necessary to sustain delivery system changes, but alignment across payers is critical for healthcare provider buy-in.


Assessing and Promoting Value: Measurement for PCMHs must be aligned and focused on value for patients, providers and payers.


To read the full report, click here.



(Sources: The Patient-Centered Medical Home’s Impact on Cost and Quality, Annual Review of Evidence 2014-2015, Patient-Centered Primary Care Collaborative, February 2016 and “Medical Home Finances Improving: Analysis,” HFMA Weekly News, February 12, 2016)



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