I recently led a discussion with the leadership of a primary care network about patient-centered medical homes (PCMHs) and care transformation. PCMH practices have attributes that enable them to increase quality of care, reduce costs, and manage health of populations by being "patient-centered" (eg, providing easier access to care through extended hours) and elevating the primary care clinician's role as an ongoing coordinator of care.
That may sound like "normal operations" for many primary care practices, and one of the criticisms of PCMH designation is that it can just be a checklist rather than substantive transformation. That is why to be considered "successful," PCMH practices must also be assessable with clinical and financial metrics.
Pilots and demonstrations of PCMH practices have found that in the process of improving quality and reducing costs, not all types of care are reduced. For example, the number of primary care visits and spending on prescription medicines both increased, while ED visits and total costs were reduced. That shouldn't be surprising since people with complicated chronic conditions like fragile diabetes, CHF, or COPDare a significant portion of the very expensive patients in most adult populations, and they do better clinically and require less costly care if they see their PCPs more often, their care is carefully monitored, and they take their medications appropriately.
