- Federally qualified health centers (FQHCs) and safety net clinics can successfully reach patient-centered medical home (PCMH) designation with adequate government funding, according to a recent RAND Corporation report.
The study, published in the New England Journal of Medicine, followed FQHCs enrolled in the Federally Qualified Health Center Advanced Primary Care Practice Demonstration.
CMS and the Health Resources and Services administration held the Demonstration between 2011 and 2014. The Demonstration enlisted and funded FQHCs across the country in their PCMH goals.
The RAND researchers compared Demonstration participants with other FQHCs to determine the extent to which government funding helps safety net clinics adopt PCMH principles.
“Although many federally qualified health centers have historically provided patient-centered, team-based care, the implementation of other medical-home components, such as expanding access to care after hours and developing data-analytic capabilities, may present substantial challenges in health centers that have limited financial resources or high staff turnover,” the researchers said.
The researchers used billing data and Medicare beneficiary surveys to assess PCMH success due to government funding.
Overall, 70 percent of Demonstration FQHCs were successful in receiving full PCMH distinction, but it took them the full three years to do so. Eleven percent of non-Demonstration participants still received the highest level of PCMH, while 26 percent received intermediate distinctions.
Over the course of the study, patient visits declined in both the Demonstration and control practices. However, the drop was smaller for the Demonstration group, likely because of expanded access to medical treatment. Patients in these clinics reported a noticeable increase in treatment access at intervention clinics.
The researchers also found that full PCMH distinction did not decrease the number of patient specialty care visits, acute care services, or Medicare expenditures in the Demonstration group.
The study also highlighted the many challenges facing safety net clinics adopting patient-centered primary care. Patients’ long-standing disease burdens, substantial social service needs, and limited English language proficiency and health literacy serve as considerable barriers to patient-centered care in FQHCs.
The study results indicated that financial support from CMS and HRSA help safety net clinics overcome those barriers. However, Demonstration participants reported that the $6 per Medicaid enrollee per month they received through the program was still not adequate.
Transitioning to a PCHM is a lofty task and requires a bit of personnel and financial capital.
Going forward, benefactors and government funders must create paths for better financial support for safety net clinics, said RAND researcher Katherine Kahn, MD, in a statement.
"Future tests of medical home interventions in federally qualified health centers should consider alternative approaches that consider the magnitude of financial assistance and the evaluation's duration to better understand how to help federally qualified health centers implement practice change and how these changes can lead to improvements in health outcomes for vulnerable Medicare beneficiaries," explained Kahn, who is also a professor at the David Geffen School of Medicine at UCLA.
Enabling more safety net clinics to adopt patient-centered primary care models will ideally improve care for underserved patients and promote more health equity, said Justin Timbie, lead author and RAND Senior Health Policy Researcher.
"Primary care medical practices are rapidly adopting the patient-centered medical home model of care and one result may be that under-served patients use more services once it becomes easier to access care," Timbie concluded. "There also is evidence that improvements in primary care may lead to reductions in specialty care and cost over a longer period than we examined in this study."