Research on “patient-centered medical homes” (PCMHs) consistently finds they have little or no effect on medical costs and mixed effects on quality. This paper by Rosenthal et al. confirms that research. The paper evaluated the Colorado Multi-Payer Patient-Centered Medical Home Pilot, one of the earliest tests of the PCMH concept administered by multiple insurers.
It doesn’t have to be this way. Lack of health insurance, unaffordable out-of-pocket costs, network restrictions, preauthorization requirements, penalties for readmissions, all stem from our private-insurance-based system.
In this comment I focus not on CMS’s costs, but the costs incurred by the FQHCs that “transformed” into “medical homes.” RAND reports that it is unable to determine what those costs are and what the “medical homes” do with the subsidies they receive from CMS.
One of the hottest new fads in managed care is “patient engagement,” aka “patient activation.” How hot? So hot Health Affairs devoted its February 2013 issue to the subject. But this fad is being sabotaged by a slightly older fad – pay-for-performance (P4P).
In July the RAND Corporation released a report on the second year of CMS’s three-year “medical home” experiment with federally qualified health centers (FQHCs). The report concluded the clinics in the “medical home” arm of the experiment were spending more money than clinics in the control arm, and that this was unlikely to change by the end of Year 3. Sad to say, we’re never going to know what it was the experimental clinics did that raised their costs
In this op-ed, Ezekiel Emanuel and his co-author admit health care inflation is heating up and accountable care organizations (ACOs) are failing to cut costs. Those are significant admissions coming from Emanuel, one of the planet’s most aggressive proponents of ACOs.
Managed care proponents suffer from the free-lunch illusion – the illusion that the managed care interventions they support are free or, at worst, cost so little those costs can be totally ignored in reporting the alleged savings achieved by the intervention. This illusion is rarely questioned by reporters or editors of professional journals.
Uncontrolled inflation of health care costs continues unimpeded as insurers, hospitals, drug companies, and others in the medical-industrial complex embrace expanded and subsidized new markets with minimal oversight. This problem is growing worse as insurers and hospitals consolidate, gain near-monopoly market shares, and raise their prices to what the traffic will bear. Meanwhile, the bureaucracy and cost of the ACA’s infrastructure continues to grow.
The annual “churn” rate among Medicare accountable care organization (ACO) doctors and assigned patients is enormous: It averages around one-third for both doctors and patients. Because of this constant doctor and patient turnover, ACOs lose the majority of their assigned patients over a five-year period. How is an ACO supposed to be held “accountable” for services given to such a rapidly changing panel of patients by such a rapidly changing roster of physicians?
Stuart Guterman’s characterization of CMS’s latest report on the Pioneer ACO program is accurate. It is impossible to explain the report’s findings.
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