AHRQ Says the Patient Centered Medical Home (PCMH) Does Not Lower Health Care Costs. Here's 5 Reasons To Not Believe Them
Posted Aug 09 2012 12:25am
While you read the following, keep in mind:
1. Using traditional research to detect a "statistically significant" decrease in insurance claims expense is notoriously difficult.
2. There's scientific statistical proof and then there is a reasonable business assurance. The latter may be enough for business-minded health insurers.
3. The conclusion is based on published research. Unpublished "in house" data have convinced many insurers to include the medical home in their covered benefit. They know something AHRQ doesn't.
4. While medical homes alone may be insufficient to save money, that doesn't mean that medical homes that are part of a package of interventions (value-based purchasing, P4P, vendor-based population health management or an ACO) are unnecessary.
5. While there is no evidence of savings, there is also no consistent evidence of increased cost. That means the quality associated with the medical home represents high value.
However, three observational studies specifically designed to test PCMH do report lower inpatient and emergency department utilization among patients in the PCMH program. However, total costs were not statistically different for PCMH and non-PCMH patients in the three studies. None of the clinical trials of functional PCMH interventions had statistically significant differences between intervention and control arms for inpatient or emergency department utilization.
No studies reported statistically significant cost savings among PCMH patients. In fact, when taking into account program costs, two studies, one good-quality trial and one fair-quality observational study, reported greater total costs among intervention patients."