A recent report on patient engagement and a separate audit of North Carolina's famed Medicaid medical home program illustrate just how difficult it is to reach solid conclusions on the value of patient-centered medical homes.
The first report, which was published in the February issue of Health Affairs, concludes that patients who are more engaged in their health have better outcomes than those who do not, and they also cost the overall healthcare system less money. Looking at the records of more than 30,000 patients, a researcher from Minnesota's Fairview Health System concluded that those who were least active in their own healthcare cost 8 percent more in the first year and 21 percent more in the second.

Engagement by patients and their families in patients? medical care is one of the core principles of medical homes and their cousins, accountable care organizations. This is surely one of those low-hanging-fruit ideas that good physicians, hospitals and health plans should have been embracing for decades. Now that there are measurements around patient engagement ? and bonuses for providers who do a good job of it?maybe it will be a movement that will actually occur.

The second study illustrates systemic problems in a state-run fee-for-service program serving the poor in North Carolina. The program, called Community Care of North Carolina, has been lauded for years as an example of how better coordination of care through physician groups can save state Medicaid dollars.
Except the savings aren?t quite as advertised?at least according to a new state auditor's report.

State Auditor Beth Woods reported that the program, which has been in place since 1998, fell $39 million short of the $90 million savings it had projected for 2012. She also took issue with conclusions from Milliman, the actuarial firm, which reported in December 2011 that the program had saved the state $984 million between fiscal 2007 and 2010.

Since the state audit was released, North Carolina has asked for a study to determine whether the medical homes are in fact saving money and improving health outcomes.

Over the past decade, Community Care of North Carolina has been a poster child for how medical homes can work in the public sector, and it also allowed the state to maintain its aversion to HMOs, even as the majority of other states has concluded that private health plans may be an answer to controlling Medicaid costs.

Community Care may or may not have raised the level of care for Medicaid patients in North Carolina. Clearly, though, medical home programs in North Carolina and elsewhere are under a higher level of scrutiny on whether money, especially public money, is being spent at its highest use.

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