Thoughtful elderly man sitting alone at home with his walking cane

High-cost patients receiving care through patient-centered medical home (PCMH) programs are less likely to remain high-cost in the long term, according to a recent study published in the American Journal of Managed Care.

PCMH programs, according to the Agency for Healthcare Research and Quality, provide patient-centered, comprehensive care by coordinating networks of primary, acute and post-acute providers. Oftentimes, units such as home health agencies and community-based supportive services are used to facilitate care transitions and medical team communication, and create more easily accessible healthcare services.

The researchers compared the healthcare expenditures and health outcomes of thousands of PCMH and non-PCMH patients across Maryland during the state’s Multi-Payer PCMH program. They found that high-cost patients, such as those with chronic conditions, frailty or greater rates of hospital or ambulance usage, experienced better health outcomes with less health service utilization. PCMHs actually reduced the likelihood that a high-cost patient remained under their high-cost designation by 34%, according to the study.

High-cost patients, though they made up less than 7% of the study’s total sample population, accounted for more than one-third of the healthcare costs during the study period, based on payer reimbursement data. Often, these patients have a higher rate of inpatient service and ambulance utilization, leading to their high-cost status. For payers, among patients who shed their high-cost designations there was an average annual healthcare expenditure drop of nearly $500 per patient, according to the study.

“The PCMH’s pronounced effect on curbing excessive expenditure levels among the costliest patients in this state supports the model’s potential to alter the population distribution of health expenditure as it becomes more widely implemented nationwide,” the researchers wrote. 

Among the programs’ specific benefits, patients in PCMH programs experienced reduced inpatient care and emergency department visits. The researchers also noted that the programs promoted care continuity, which “fosters improved patient outcomes and reduced expenditure in individuals with chronic conditions.”