Looking for doubts about the viability of medical homes. Check out the February 2012 issue of The American Journal of Managed Care. Looking for affirmation of medical homes. Check out the March 2012 issue of The American Journal of Managed Care.

Nobody said that change was going to be easy. The U.S. healthcare system is a big ship to turn around, and both articles in AJMC make valid points about medical homes, which have been billed as the best approach to delivering better healthcare. Medical homes are a way of organizing care so that a primary-care physician works with a team of professionals to coordinate a patient's care. The team can include a nurse practitioner, dietitian, social worker, pharmacist and specialists, with all having easy access to medical records and a system set up to reinforce the best treatment for the chronically ill.

Just about every state has some kind of medical home pilot underway, sponsored by commercial insurers, Medicaid programs, physician groups and others, and some of these have been around for a number of years. So it seems logical that enough data would be available to determine whether these programs are saving money.

But according to the article published in the February AJMC, few studies over the past decade provided rigorous quantitative evaluation of medical homes. Out of 498 studies done from January 2000 to September 2010, only 14 were deemed adequate for review by the AJMC authors. In order to be included in the study, the evaluations had to examine programs that included at least three of five key patient-centered medical home components, and they had to include a quantitative study of outcomes.

The conclusion of researchers was that much more rigorous evaluations are needed to definitively assess medical homes.

A much more optimistic assessment appeared in AJMC a month later, though, in an evaluation of Geisinger Health System's medical home program, called the ProvenHealth Navigator. This study looked at 43 primary-care clinics converted into ProvenHealth Navigator sites between 2006 and 2010. It found that total cumulative cost savings were 7.1 percent when accounting for effects from prescription drug coverage, and savings were 4.3 percent using the model that does not include prescription drug coverage interaction effects. The study indicated that the Geisinger program had not yet exceeded the break-even point in return on investment. But its conclusion was that patient-centered medical homes can lead to significant and sustainable cost savings over time.

The less-optimistic AJMC piece from February wisely points out that a number of promising healthcare interventions have been shown not to actually work when evaluated using rigorous methods. It gives the example of how telephonic disease management was found to be ineffective in randomized trials, but these trials pointed the way to better, more-focused disease management programs with in-person contact. Similarly, programs like Geisinger's could point the way to medical homes that start repairing our fragmented, inefficient healthcare system.

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