PCMH Model Reduces High-Cost Utilization at Veterans Health Administration

A recent study in the American Journal of Managed Care found that use of a patient-centered medical home model helped to reduce costs at the Veteran’s Health Administration.

“The Veterans Health Administration provides care to nearly 6 million veterans each year at more than 1000 clinics across the country,” Ian Randall, PhD, of the VA Puget Sound, Health Services Research & Development Center of Innovation at the US Department of Veterans Affairs, and colleagues wrote in the study. “On April 1, 2010, the Veterans Health Administration implemented a patient-centered medical home (PCMH)-based Patient Aligned Care Teams (PACT) model across the VHA system. We analyzed Veterans Health Administration clinical and administrative data to conduct an interrupted time series study.”

The researchers classified 642,600 patients with PTSD into either a high PCMH implementation group or a low PCMH implementation group using a Veterans Health Administration PCMH measurement instrument. They compared the instances hospitalizations, primary care visits, specialist visits, mental heath visits, emergency department utilization, and urgent care utilization between high and low PCMH implementation groups.

Study results showed that patients in the high PCMH implementation group had a reduced amount of hospitalizations, fewer mental health visits, fewer ED visits, and fewer urgent care visits. The researchers concluded that reduced utilization of high-cost specialty services could be achieved through use of a PCMH model.

However, the researchers noted that the PCMH model did not have the added benefit of increasing primary care provider visits, indicating the program may not be entirely beneficial for patients.

“For patients to realize the benefits of enhanced primary care, we anticipate that they would have more frequent and regular contact with their primary care clinician teams,” Dr Randall and colleagues wrote. “This effect was not observed. If Patient Aligned Care Teams is simply driving reduced access to care across the range of health services, it is difficult to conclude that the model has succeeded in its broader aims.”

—David Costill