A key to the Affordable Care Act is to improve population health and cut wasted U.S. medical spending by focusing on chronically ill patients and insuring they get timely, well-coordinated medical care that keeps them out of the hospital.
A new study published Monday in the Plainsboro-based American Journal of Managed Care suggests this approach is working.
The use of a patient-centered medical home model, which is where patients get extra attention and follow-up to care for those with chronic illness, reduced costs and trimmed hospital utilization for high-risk patients, according to the three-year study.
The study involved 700 patients of Independence Blue Cross of Pennsylvania, most of whom had multiple chronic illnesses such as congestive heart failure, chronic obstructive pulmonary disease, diabetes and asthma. Patients with these illnesses typically experience a disproportionately high number of hospital stays and use more health care services.
The study found that PCMH patients had fewer hospital admissions than the control group: 10.8 percent fewer in 2009, 8.6 percent fewer in 2010, and 16.6 percent fewer in 2011, according to the study. In addition, in 2009 and 2010, there was a savings in total medical costs of 11.2 percent and 7.9 percent, respectively, for the PCMH high-risk group. The study authors are Susannah Higgins, Ravi Chawla, Christine Colombo, Richard Snyder and Somesh Nigam.
“These results are promising,” said Joel Cantor, director of the Rutgers Center for State Health Policy. “A lot of stock has been put in the patient centered medical home model, with the hope that better care can also reduce cost.” He said the study found that savings were achieved “among the highest risk, sickest patients. Over time, investing in models like this one are likely to have an important payoff for the patients who are the main drivers of high health care costs – those with complex chronic illnesses.”
In New Jersey, numerous patient-centered programs have been rolled out in the last few years by Horizon Blue Cross Blue Shield of New Jersey, which now has more than 500,000 of its members enrolled in these innovative programs. In a 2012 study of their impact, Horizon reported that the cost of care was six percent lower among the Horizon PCMH practices compared to non-PCMH practices. Horizon spokesman Tom Vincz noted that the Horizon results reflect all the PCMH patients, not just the chronically ill patients.
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