Commonwealth Fund reports Colorado medical home pilot reduced ED use and costs

According to a Commonwealth Fund study, a multipayer medical home program piloted in Colorado led to a sustained reduction in emergency department use and costs over three years, although there were no overall cost savings for practices or patients. Primary care visits also decreased. The impact on quality was mixed: cervical cancer screening rates improved, yet colon cancer screenings and hemoglobin testing for diabetes patients decreased.

The goal of Patient Centered Medical Homes (PCMH) are to deliver primary care services in a proactive, coordinated manner and improve quality of care, including patient health outcomes– particularly those with multiple or complex care needs.  In addition, the PCMH goal is to lower by reducing the need for expensive hospital stays and emergency department visits.

The Commonwealth Fund research evaluated a pilot program involving 15 PCMH practices in Colorado serving approximately 98,000 patients both prior to the program’s launch and then again at two and three years.

Key Findings from the Commonwealth Fund Report:

  • After 2 years, participating PCMH practices reduced their patients’ use of the ED by approximately 7.9 percent. At the end of three years, they had sustained this improvement with a 9.3 percent drop from baseline.
  • Among patients with two or more illnesses, there was a 10.3 percent drop from baseline in the rate of hospital admissions for conditions that could be have been avoided had timely treatment been provided in an ambulatory care setting.
  • After three years, the program reduced ED costs by $3.50 per member per month, a drop of 11.8 percent. For patients with two or more conditions, the reduction was $6.61 per member per month, or 14.5 percent.
  • The PCMH pilot practices saw a decline in primary care visits. At three years, there was a reduction of 4.2 primary care visits per thousand member-months.
  • Cervical cancer screenings improved by 4.7 percent after two years and 3.3 percent after three years. However, the pilot also was associated with lower rates of hemoglobin A1c testing in diabetes patients and lower rates of colon cancer screening.