Report: ACOs With PCMHs Perform Better

August 9, 2018 · Adam O'Neill

Yesterday the Patient-Centered Primary Care Collaborative (PCPCC) released a report examining how advanced primary care models – like the patient-centered medical home (PCMH) –impact the success of ACOs.

Overall findings:

• Advanced primary care – and particularly the PCMH – help ACOs improve quality and generate savings.
• Other characteristics, such as culture/leadership, benchmarks and proportion of ACO patients in a practice, also contribute to shared savings.
• Success of ACOs is more than just savings: While only one-third of MSSP ACOs attained shared savings, the large majority of ACOs improve quality.

PCMH-Specific Findings

The report looked at quality and savings for ACOs with varying shares of primary care practices recognized by NCQA as a PCMH. The report found:

• ACOs with a higher share of primary care physicians in an NCQA PCMH demonstrated higher quality, specifically:
  • Higher health promotion and health status scores.
  • Higher preventive service scores.
  • Better chronic disease management scores (assessing whether disease markers were controlled and whether patients were receiving evidence-based therapy).
• ACOs that had higher rates of PCMH primary care practices were more likely to generate savings.
• ACOs with higher PCMH penetration rates did better on:
  • Pneumococcal vaccination rates.
  • Tobacco assessment cessation.
  • Depression screening scores.
  • Diabetic and coronary artery diseases composite measures.

The report used a literature review and expert analysis, as well as data analysis of NCQA-Recognized PCMHs participating in ACOs. Prior to this report, there were no peer-reviewed articles that examined the relationship between advanced primary care models and ACOs beyond a single health system.

The literature review found that successful ACOs are strong in the following areas:

1. Leadership and Culture.
2. Prior Experience.
3. Health Information Technology.
4. Care Management Strategies.
5. Organizational and Environmental Factors.
6. Incentive and Payer Alignment.

These themes match components of the PCMH and align with feedback NCQA often gets from practices, payers and consultants about what makes medical homes succeed. One theme in the findings particularly emphasized leadership and staff buy-in—the very things necessary for successful implementation in PCMH.  Guidance on how to get staff buy-in is included in NCQA’s MACRA Toolkit.

Learn more about the PCPCC Report:

• 2018 Evidence Report (full).
• Executive Summary.
• Evidence Report White Paper.

NCQA keeps a compendium of research and reports related to the PCMH. See NCQA’s Evidence Report or learn more about NCQA PCMH Recognition.