The Commonwealth Fund released a new brief this week detailing recommendations made by the Patient-Centered Medical Home Evaluators’ Collaborative for an initial set of standardized measures for evaluating medical home initiatives.
Experts have long agreed that excellent primary care is essential for a strong healthcare system, and now, they are looking more closely at the patient-centered medical home (PCMH) as a viable alternative to a primary care system in desperate need of transformation. More than 90 commercial health plans, 42 states and three federal initiatives are currently implementing the medical home model which incorporates components of primary and patient-centered care, innovations in practice redesign and technology as well as modifications in provider payment methods.
Although implications definitely point to the production of positive effects on efficiency, quality and cost, little data supporting the medical home’s true impact has been published thus far. Extensive information is still needed to convince policymakers, purchasers, payers, clinicians and patients of the model’s promise.
With this in mind, the Commonwealth Fund established the PCMH Evaluators’ Collaborative in 2009 to develop and align evaluation methods, share best practices and produce data that can help shape policy and improve model design. More than 75 researches, actively engaged in PCMH pilots, joined the collaborative and divided into five work groups each assigned to concentrate on a key dimension of PCMH evaluation:
- Cost and utilization
- Clinical quality
- Patient experience
- Clinician and staff experience, and
The groups worked diligently to review literature, develop logic models and debate possible measures for evaluating each dimension as well as identify feasible data collection instruments. By 2011, researchers began publishing and presenting their recommendations on the national stage.
Because the medical home’s potential for increasing efficiency and cutting costs while simultaneously improving quality has firmly positioned the concept to remain at the forefront of important health reform discussions, members of the collaborative met in June 2011 to specifically discuss the recommendations of the cost/utilization and clinical quality work groups with the goal of building consensus around a minimum set of measures that would enable meaningful cross-study comparison.
Members of the collaborative largely supported the cost and utilization group’s recommendation that core utilization measures should include:
- Emergency department visits,
- Hospitalizations and
- Readmissions within 30 days.
There was also consensus that evaluations should always include analysis of total per member per month cost effects for high-risk patients. Researches delved into several more technical issues as well but did not reach a consensus as to how these issues should be handled. They did suggest, however, that all utilization and cost issues be risk-adjusted and that pricing needs to be standardized and as transparent as possible.
The June 2011 discussion also brought validation to the importance of assessing changes in clinical quality within medical home programs. Participants agreed that evaluators should use standardized, nationally endorsed measures in this regard, and they identified five key areas of primary care measurement:
- Preventive care,
- Chronic disease management,
- Acute care,
- Overuse and
Separate core clinical quality measure sets were established for adult and pediatric patients. In addition, researchers specified that evaluators need to use an authenticated approach to collecting data, especially when extracting from medical or electronic health records, as well as consistent measures across practices within a demonstration.
To learn more about the recommendations for Measuring the Success of the Patient-Centered Medical Home take a look at these slides used in a webinar hosted by The Commonwealth Fund earlier this week.