Medical home model shows promise with insurers

March 18th, 2015

It’s no secret that the US is lagging well behind other developed nations in delivering and coordinating healthcare, as this report from the Commonwealth Fund shows. But thanks to some Affordable Care Act incentives, some insurers have been stepping up their game and experimenting with new payment models. Both WellPoint and UnitedHealth are expanding their use of accountable care organizations. And last week, BlueCross BlueShield announced it has directed more than $65 billion into value-based care programs such as patient-centered medical homes.

One of the insurer’s largest medical home experiments is the CareFirst program in the DC area, which reported last week that it saved $130 million in medical costs for its 1.1 million members, and cut hospital admissions by 6.4%. Days spend in the hospital were down by 11.1%. Physicians can receive up to 36% more in reimbursements for hitting quality goals.

The medical home model is not perfect, however. Critics say that more financial penalties are needed for hospitals and physicians with high levels of poor outcomes in patients -- similar to penalties in the new Medicare payment model. And a study of 32 medical homes from the February issue of the Journal of the American Medical Association found limited quality improvement and no reduction in hospital stays or ED utilization from the beginning to the end of the three-year pilot study. While medical homes certainly won’t change the landscape of care delivery overnight, these baby steps are worth exploring further.