Med­i­cal home find­ings out-of-date

Modern Healthcare - - COMMENT - By Mar­garet O’Kane Mar­garet O’Kane is pres­i­dent of the Na­tional Com­mit­tee for Qual­ity As­sur­ance.

There’s an old say­ing that any pub­lic­ity is good pub­lic­ity—but out­dated in­for­ma­tion can mis­lead. Well-in­formed voices must speak up in that case.

That’s our sit­u­a­tion at the Na­tional Com­mit­tee for Qual­ity As­sur­ance fol­low­ing pub­li­ca­tion of a JAMA study on pa­tient-cen­tered med­i­cal homes. Al­though com­mend­able in its fo­cus, the study con­tains mis­con­cep­tions.

As long­time ad­vo­cates of the model, NCQA be­lieves in the power of med­i­cal homes to trans­form pri­mary-care prac­tices. Our PCMH recog­ni­tion pro­gram is the na­tion’s largest—roughly 10% of all pri­mary-care clin­i­cians in the U.S. par­tic­i­pate at nearly 7,000 prac­tice sites. Par­tic­i­pat­ing prac­tices must meet rig­or­ous stan­dards for ad­dress­ing pa­tient needs, work­ing with pa­tients in longterm part­ner­ships, rather than through hur­ried, spo­radic vis­its.

We rec­og­nize that pri­mary-care trans­for­ma­tion is a process and that NCQA stan­dards must keep up with the times. Since its launch in 2008, our med­i­cal-home pro­gram has been up­dated twice—in 2011 and again this year—and it is con­stantly evolv­ing based on what we learn from prac­tices, col­lab­o­ra­tives and spon­sors. Pro­gram in­cen­tives have evolved in many mar­kets from sim­ple adop­tion of the stan­dards to achiev­ing triple-aim goals—im­proved qual­ity, cost and pa­tient ex­pe­ri­ence.

Un­for­tu­nately, the re­cent JAMA paper, sug­gest­ing low im­pact from PCMH mod­els, as­sessed prac­tices with 2008 stan­dards, rather than the more re­cent ones. Con­se­quently, re­sults are out­dated and un­in­ten­tion­ally mis­repre- sen­ta­tive. It’s like look­ing at a 2008 Black­Berry to as­sess the iPhone 5. The world has changed, and so have stan­dards for med­i­cal homes.

The JAMA paper also con­tra­dicts stud­ies show­ing that med­i­cal homes re­sult in clear im­prove­ments in cost, qual­ity, ac­cess and pa­tient ex­pe­ri­ence. One anal­y­sis re­leased this Jan­uary by the Pa­tient-Cen­tered Pri­mary Care Col­lab­o­ra­tive found that 61% of peer-re­viewed stud­ies iden­ti­fied re­duc­tions in per-mem­ber per-month costs and in the use of un­nec­es­sary or avoid­able ser­vices.

Work­ing to­ward mea­sur­ing out­comes in med­i­cal homes is an NCQA pri­or­ity. Our goal is a bal­ance of struc­tural and per­for­mance mea­sures. At this point, how­ever, struc­tural mea­sures are the best op­tion un­til we have broad agree­ment and good data sources on the best out­come mea­sures to use in eval­u­at­ing med­i­cal homes. We will work to forge con­sen­sus on ap­pro­pri­ate pa­tient-reporting tools and on the best sources for qual­ity and uti­liza­tion data.

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