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IBC medical home study in The American Journal of Managed Care finds lower costs for chronically ill

Three-year study shows reduced costs and hospital utilization for highest risk patients

Philadelphia, PA – March 24, 2014 – Results from a three-year study by Independence Blue Cross (IBC) demonstrating reduced costs and utilization for high-risk patients cared for by patient-centered medical homes appear today in The American Journal of Managed Care. The study involved approximately 700 IBC members — most with multiple chronic illnesses including congestive heart failure, chronic obstructive pulmonary disease, diabetes, and asthma — who experience a disproportionately high number of hospital stays and costly health care services.

In the study from 2009 to 2011, the group of high-risk patients treated in primary care practices that made the commitment to transform into a patient-centered medical home (PCMH) had fewer hospital admissions than the matched control patients not treated in medical homes: 10.8 percent fewer in 2009, 8.6 percent fewer in 2010, and 16.6 percent fewer in 2011. In addition, in 2009 and 2010, there was a savings in total medical costs of 11.2 percent and 7.9 percent, respectively, for the PCMH high-risk group.

“It is gratifying to see that better coordinated primary care, directed at people who are the most ill, works,” said Somesh Nigam, IBC’s chief informatics officer and a contributor to the study. “The rigorous methodology used to focus on this vulnerable population was critical to show the benefit of medical homes in a dynamic health care environment.”

This is the first in a series of publications authored by IBC Informatics which will show the benefits of PCMH for those with chronic conditions.

“These findings demonstrate the favorable impact of the PCMH on improving quality and lowering the cost of care for those patients who are most seriously ill and have the most to gain from better access and coordination of care. This is especially relevant in light of the Affordable Care Act, which includes provisions that support the medical home model,” said Richard Snyder, MD and chief medical officer at Independence Blue Cross. “We are proud to support primary care practices that commit to become recognized as medical homes. The primary care physicians who transformed their practices deserve tremendous credit.”

“These results also supplement our understanding of the impact of the PCMH as recently reported by researchers at the RAND Corporation who found very limited benefits of PCMH when considering healthy and chronically ill patients together,” added Nigam. The Rand study involved 120,000 patients in 32 medical homes that were part of the southeastern Pennsylvania Chronic Care Initiative.

Practices which achieve recognition by the National Committee for Quality Assurance (NCQA), a private, non-profit organization dedicated to improving health care quality, as a PCMH deliver more coordinated care, measure their own performance, and hold themselves accountable for better access, better outcomes, and a better experience for their patients and their families. IBC has been a pioneer in promoting this effort to improve primary care and continues to collaborate with a broad coalition of interested stakeholders to drive transformation. Nearly 40 percent of primary care practices in IBC’s network are NCQA-recognized medical homes. For the last four years, IBC has offered a direct financial incentive to practices that achieve recognition as a patient centered medical home.

“This study shows that PCMH with the right incentives, plus a strategic focus on the patients with the greatest needs, is a win for the patient, the insurer and, the practice,” said Peggy O’Kane, NCQA president. “We congratulate the practices who worked so hard to get these results.”

“This important study confirms what other researchers and practices have discovered, that the most costly patients — for example those who are the most ill — are where most of the cost savings can be found,” said Dr. Marci Nielsen, CEO of the Patient-Centered Primary Care Collaborative.”

About Independence Blue Cross
Independence Blue Cross is the leading health insurer in southeastern Pennsylvania. With our affiliates, we serve more than 7.5 million people nationwide, including 2.2 million in the region. For more than 75 years, we have been enhancing the health and wellness of the people and communities we serve by delivering innovative and competitively priced health care products and services; pioneering new ways to reward doctors, hospitals, and other health care professionals for coordinated, quality care; and supporting programs and events that promote wellness. To learn more about how we’re changing the game, visit Connect with us on Facebook at and on Twitter at @ibx. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.

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