- Could integrating the patient-centered medical home into accountable care organizations be the key to driving care quality and cost savings? According to one new report from the Patient-Centered Primary Care Collaborative (PCPCC), it could be.
The patient-centered medical home (PCMH) is an advanced primary care model defined by patient-centricity, increased patient access to care via health technology and open office hours, and coordinated, team-based care.
Accountable care organizations (ACOs) work to cut healthcare costs by driving better patient engagement, care access, and primary care. In delivering on those principles, ACOs should be able to keep patients healthier and reduce high-cost healthcare utilization.
Many of these factors overlap or support one another, the researchers stated. Specifically, the goals in PCMHs align with the fundamental effort for ACOs to improve primary care.
The researchers examined different trends between successful ACOs and how their defining characteristics overlapped with different principles in the PCMH model. Do ACOs that embrace more of these key factors see greater success rates?
According to the literature review, they do, PCPCC reported. This is primarily because of the significant overlap in ACO and PCMH principles.
“A review of published evidence, expert opinions, and secondary data analysis suggests the interdependence of advanced primary care models (such as the PCMH) and ACOs in achieving improved population health, lower costs, and better patient experiences in health care,” the report authors said.
This is because of the key focus for the different care models. For example, ACOs primarily focus on population health management as a means to cap acute and post-acute care spending. Those care goals depend on strong primary care delivery, care coordination, patient-centered care, and patient access to care, all of which are also key elements of the PCMH.
The research supports this idea, the PCPCC added. Studies investigating ACOs that have a strong advanced primary care emphasis – such as ACOs with a high population of providers also involved in a PCMH – tended to perform better than ACOs that did not embrace advanced primary care.
ACOs with PCMH participation tended to see higher cost savings, higher quality care scores, and lower utilization of emergency department and inpatient services.
Some studies investigated did indicate mixed results, the PCPCC researchers acknowledged. One study showed that care quality is inconsistent and depends on factors such as patient panel and environmental characteristics. Another study suggested that care quality plateaus.
The PCPCC report also looked at the saturation of PCMH providers in ACOs and how that determines the success of the ACO. Notably, ACOs with more providers embracing the PCMH model performed better.
“Having a higher share of PCMH PCPs was associated with higher health promotion and higher health status scores,” the researchers reported. “The preventive service scores were also generally higher: having a higher share of PCMH PCPs was associated with higher pneumococcal vaccination and depression screening scores.”
As hypothesized, the researchers concluded that the success of tandem ACOs and PCMHs is the result of overlapping patient-centered care principles. ACO success depends on patient engagement, improved access to care, care coordination, and an emphasis on comprehensive primary care. Those very principles are at the heart of the PCMH, making the model a key indicator of ACO success.
For example, ACO emphasis on leadership and culture change is tied to person- and family-centered care and team-based collaboration in PCMHs. The ACO focus on health IT is also associated with greater care access, care coordination, and care continuity in PCMHs.
The findings have some policy implications, the report authors noted. As the healthcare industry continues to examine how ACOs drive high-quality, low-cost care, it will be incumbent on policymakers to understand the drivers of successful ACOs.
“Given these results and the desire of policy makers and accountable health system leaders to derive increasingly better results from delivery and payment transformation, policies that encourage a strong primary care orientation for ACOs should be considered,” the researchers concluded. “This orientation could include PCMHs and policies that promote the six characteristics identified in the literature review.”