Independence Blue Cross Study in Health Service Research Finds Fewer Emergency Room Visits for Chronically Ill Patients Treated in Patient-Centered Medical Homes

Largest study of its kind shows nearly an 8 percent reduction in emergency visits, primarily for those with diabetes, heart disease and high blood pressure

A study authored by Independence Blue Cross (Independence) and CTI Clinical Trial and Consulting Services (CTI) demonstrating fewer emergency department visits for chronically ill patients cared for in a patient-centered medical home has been published by Health Services Research. Health Services Research is a peer-reviewed journal published by Health Research and Educational Trust, and is the official publication of Academy Health which publishes original investigations that expand understanding of the wide-ranging field of health care.

Using claims data from approximately 460,000 Independence beneficiaries enrolled in 280 primary care practices, the authors of the manuscript titled: "Do Patient-Centered Medical Homes Reduce Emergency Department Visits?" found that the transition to a medical home was associated with a statistically significant 5 to 8 percent reduction in ED utilization. This finding is specific to patients with chronic illness(es) having one or more Emergency Department (ED) visits in any given year. These reductions were most evident among patients with diabetes, who experienced a 9.5 to 12 percent reduction.

"One interesting finding is that reductions in ED admissions are not coming necessarily from the fact that medical homes are open for longer hours or are more accessible to patients, but from better management of chronic conditions," said Guy David, PhD, the study's lead author, CTI Academic Affiliate, and health management professor at Wharton School of the University of Pennsylvania. David also noted that the research, which involved more patients than any other study of its kind, showed the most significant reductions in ED visits for patients who have either hypertension or diabetes. "We also were able to see what happened to both a practice's total patient population and an individual patient in a practice that becomes a medical home. We can also follow a patient and see if there is a different experience before and after the medical home transition," said David. A video of David speaking about the study can be found here.

Patient-centered medical homes improve patient health and lower costs through a team-oriented approach to primary care. This includes more coordinated care among all health care professionals, electronic health records to better track care, open scheduling to allow for more flexibility in seeing patients when they need care, and more interaction with the physician and staff between appointments to make sure scheduled tests and consultations occurred.

"These latest results show another exciting aspect of the benefits of medical homes, which have demonstrated in our previous studies that they help reduce costs and improve the health of chronically ill patients," said Somesh Nigam, Independence's senior vice president and chief informatics officer and a contributor to the study. "Medical homes are particularly beneficial to this high-risk or chronically ill population because of the added resources they receive, such as care managers and dieticians that provide regular outreach from doctors and their staff about test reminders, preventive care, and other information and support. Care is also more coordinated and problems are addressed quickly so they don't become worse and result in an emergency room visit or complication."

"Potentially avoidable ED visits are a major concern for health systems," says Candace Gunnarsson, CTI's Vice President, Health Economics and Outcomes Research. "Some patients' needs could be addressed in a lower-intensity setting like retail or urgent care clinics. Additionally, patients with chronic illnesses may be seeking treatment for acute illness episodes that might have been avoided through better disease management. Medical homes focus on improving patient access, care coordination, and illness management and have generated considerable interest as a vehicle for improving patient care, especially among those individuals needing treatment for chronic illnesses." 

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