PCMH Evidence

Patient-Centered Medical Homes are driving some of the most important reforms in health care delivery today. A growing body of scientific evidence shows that PCMHs are saving money by reducing hospital and emergency department visits, reducing health disparities, and improving patient outcomes. The evidence we present here outlines how the medical home inspires quality in care, cultivates more engaging patient relationships, and captures savings through expanded access and delivery options that align patient preferences with payer and provider capabilities.

NCQA-Recognized PCMH Studies

Additional PCMH Evidence

NCQA Patient-Centered Medical Homes Cut Growth in Medicare Emergency Department Use: Medicare Claims & Enrollment Data

NCQA PCMHs cut the growth in outpatient ED visits by 11% over non-PCMHs for Medicare patients. The reduction was in visits for both ambulatory-care-sensitive and non–ambulatory-care-sensitive conditions, suggesting that steps taken by practices to attain patient-centered medical home recognition may decrease some of the demand for outpatient ED care.

Pines J.M., Martijn van Hasselt & Nancy McCall (2015). Emergency Department and Inpatient Hospital Use by Medicare Beneficiaries in Patient-Centered Medical Homes. Annals of Emergency Medicine.

NCQA Patient-Centered Medical Homes Lower Total Cost of Care for Medicare Fee-for-Service Beneficiaries: Medicare Claims & Enrollment Data

Medicare fee-for-service beneficiaries receiving care in NCQA-recognized PCMH practices had lower total annual Medicare spending than beneficiaries in comparison practices. Medical home implementation resulted in lower payments to acute care hospitals and fewer emergency department visits. The declines were larger for practices with sicker than average patients, primary care practices, and solo practices.

Van Hasselt, M., McCall, N., Keyes, V., Wensky, S. G., & Smith, K. W. (2014). Total Cost of Care Lower among Medicare Fee-for-Service Beneficiaries Receiving Care from Patient-Centered Medical Homes. Health Services Research.

NCQA Patient-Centered Medical Homes Lower Costs and Provide a High Return on Investment: Colorado Multipayer PCMH Pilot, New Hampshire Citizens Health Initiative Multi-Stakeholder Medical Home Pilot

NCQA PCMH recognition is associated with lower inpatient hospitalizations and lower utilization of both specialist and emergency services. Pilot programs in Colorado also produced an estimated return-on-investment (ROI) between 2.5 and 4.5 to 1.

Harbrecht, M, Latts, L. (2012). Colorado’s Patient-Centered Medical Home Pilot Met Numerous Obstacles, Yet Saw Results Such as Reduced Hospital Admissions. Health Affairs.

Raskas, et al. (2012). Early Results Show WellPoint’s Patient-Centered Medical Home Pilots Have Met Some Goals For Costs, Utilization and Quality. Health Affairs.

NCQA Patient-Centered Medical Homes Provide More Effective Care Management and Optimize Use of Health Care Services: Empire Blue Cross and Blue Shield, New York City

Patients treated within NCQA PCMH practices had equal or better care management, fewer inappropriate prescriptions as well as avoidable emergency department visits and hospitalizations.

DeVries, A, Chia-Hsuan W, Sridhar G, Hummel J, Breidbart S., Barron J. (2012) Impact of Medical Homes on Quality Healthcare Utilization and Costs. The American Journal of Managed Care.

NCQA Patient-Centered Medical Homes Lower Medicare Spending: Medicare Claims & Enrollment Data

Beneficiaries enrolled in an NCQA PCMH showed lower rates of utilization and Medicare payments across many types of services than comparison practices, particularly with regard to ambulatory care sensitive condition ER visits.

Perry R, McCall N, Goodwin S. Examining the Impact of Continuity of Care on Medicare Payments in the Medical Home Context. Presented at the AcademyHealth Annual Research Meeting, Orlando, FL, June 24, 2012.

NCQA Patient-Centered Medical Homes Improve Care Management and Preventative Screenings for Cardiovascular and Diabetes Patients: Southeast Pennsylvania Multi-Payer Advanced Primary Care Practice Demonstration

NCQA PCMH programs demonstrated significant improvements in receiving evidence-based screenings and treatment for diabetes as well as modest improvements in clinical outcomes, such as blood pressure and cholesterol.

Gabbay RA, Bailit MH, Mauger DT, Wagner EH and Siminerio L. (2011). Multipayer Patient-Centered Medical Home Implementation Guided by the Chronic Care Model. The Joint Commission Journal on Quality and Patient Safety.

Patient-Centered Medical Homes Reduce Socio-economic Disparities in Cancer Screening: Blue Cross Blue Shield of Michigan Physician Group Incentive Program

PCMHs increase highly-recommended cancer screening rates, especially for people with lower socioeconomic status, thereby reducing disparities in care.

Markovitz AR, Alexander JA, Lantz PM, Paustian ML (2015). Patient-Centered Medical Home Implementation and Use of Preventive Services: The Role of Practice Socioeconomic Context, Journal for the American Medical Association Internal Medicine.

Long-term Patient-Centered Medical Home Implementation Produces Largest Sustainable Cost Savings in Acute Inpatient Care: Geisinger Health System’s ProvenHealth Navigator

Geisinger Health System PCMHs produced greatest savings through reduced acute inpatient care, which increased over time and with further implementation of PCMH reform.

Maeng, Daniel D., Nazmul Khan, Janet Tomcavage, Thomas R. Graf, Duane E. Davis, and Glenn D. Steele. (2015). Reduced Acute Inpatient Care Was Largest Savings Component of Geisinger Health System's Patient-Centered Medical Home. Health Affairs.

Patient-Centered Medical Home Initiatives Expanded Fourfold from 2009–13
Programs that promote Patient-Centered Medical Home transformation with payment reform incentives continue to rapidly expand across the United States. Private and public payer initiatives together have grown from 18 states in 2009 to 44 states in 2013, and now cover almost 21 million patients. These heterogeneous initiatives overall are becoming larger, paying higher fees, and engaging in more risk sharing with practices.

Edwards Samuel T, Asaf Bitton, Johan Hong, and Bruce E. Landon (2014). Patient-Centered Medical Home Initiatives Expanded In 2009–13: Providers, Patients, and Payment Incentives Increased, Health Affairs. 

Patient-Centered Medical Homes Produce Lower Overall Health Costs Through Focus on Primary Care Utilization: Vermont Blueprint for Health

When compared with patients in traditional primary care practices, PCMH patients had: lower overall health care costs, lower rates of hospitalization, increase in use of non-medical support services, and lower use of specialty care but higher use of primary care.   

Department of Vermont Health Access / Vermont Blueprint for Health

Medicare Beneficiaries Have Better Patient Experience in Patient-Centered Medical Homes: John A. Hartford Foundation Primary Care Poll Series

Surveys of Medicare beneficiaries found that they want PCMH care and believe it is improving their health.

Langston C, Undem T, Dorr D. (2014). Transforming Primary Care What Medicare Beneficiaries Want and Need from Patient ‐Centered Medical Homes to Improve Health and Lower Costs. Hartford Foundation.

Patient-Centered Medical Homes Produce Most Effective Cost Savings in Highest Risk Patients: Pennsylvania Chronic Care Initiative

PCMH practices had significantly reduced costs and utilization for the highest risk patients, particularly with respect to inpatient care. As high-risk members represent a high-cost group, the most benefit can be gained by targeting these members.

Higgins S, Chawla R, Colombo C, Snyder R, & Nigam. (2014). Medical Homes and Cost and Utilization Among High-Risk Patients, American Journal of Managed Care.

Patient-Centered Medical Homes Increase Rates of Quality Improvement: New York State Medicaid and the Adirondack Medical Home Multi-payer Demonstration

New York State reported to the legislature in April 2013 that PCMH practices in the state have higher rates of quality performance, as defined by national standardized measures, than non-PCMH practices for a majority of measures.

The Patient-Centered Medical Home Initiative in New York State Medicaid: Report to the Legislature, April 2013. New York State Department of Health.

Medicaid Patient-Centered Medical Homes Increase Patient Access and Lower Inpatient Admissions and Per Member Per Month Costs: State PCMH Initiatives

In a survey of a number of state initiatives, some of which use NCQA recognition, National Association for Health Policy researcher Mary Takach found evidence of improvements in quality and reduced use of emergency room and other utilization measures.

Takach, M. (2011). Reinventing Medicaid: State Innovations to Qualify and Pay for Patient-Centered Medical Homes Show Promising. Health Affairs.

Multi-payer Patient-Centered Medical Homes Reduce Preventable Emergency Department Visits: Rhode Island Chronic Care Sustainability Initiative

Rhode Island multiple-payer PCMH initiative yielded significant reduction in emergency room visits for conditions that could be treated in a doctor’s office. The five small, independent primary care practices in the program also improved their ability over two years to prospectively manage patient populations and track and coordinate care.

M. B. Rosenthal, M. W. Friedberg, S. J. Singer et al. (2013). Effect of a Multipayer Patient-Centered Medical Home on Health Care Utilization and Quality: The Rhode Island Chronic Care Sustainability Initiative Pilot Program. Journal of the American Medical Association Internal Medicine.

Patient-Centered Medical Home Initiatives Produce 6 to 1 Return on Investment: UnitedHealth Center for Health Reform & Modernization

An actuarial evaluation of four medical home programs in Arizona, Colorado, Ohio, and Rhode Island, based on operation between 2009 and 2012 for 40,000 members, found average gross savings of 7.4% of medical costs compared to traditional primary care practices. Every dollar invested in care coordination activities produced $6 in savings in the third year (a return on investment of approximately 6 to 1). Including the cost of the intervention, the programs saved approximately 6.2% of medical costs on average.

Advancing Primary Care Delivery: Practical, Proven, and Scalable Approaches. (2014). UnitedHealth Center for Health Reform & Modernization.

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