President's Message: Getting Beyond Generalizations
A new research report published online in JAMA Internal Medicine on June 1st finds that over a three year period, Patient Centered Medical Home (PCMH) implementation in the northeast region of the Pennsylvania Chronic Care Initiative resulted in marked improvements in care. Practices adopting the PCMH model and obtaining NCQA PCMH designation performed better than a group of comparison practices on several measures of preventive care, and their patients experienced significantly lower rates of hospitalization, emergency room visits, and specialty visits (while having significantly higher rates of primary care utilization). The study contributes to a growing body of evidence addressing PCMH effectiveness. The problem is that the body of evidence remains inconclusive: some studies say that PCMH’s work; others say they don’t.
We’re faced with a similar dilemma when trying to answer the question of “does [blank] work?” where you can fill in the blank with almost any population health intervention: case management, disease management, worksite wellness, health coaching, et cetera. The answer to that question is almost always going to be “more research is needed.”
When done right (and what that means is also debatable) many interventions that conceptually makes sense will produce the desired outcome. In a crowded field of vendors, offering an array of program components in a wide variety of settings and using professionals with different training, knowledge, and organizational and social skills, it’s not surprising to continue to see variation in outcomes including and return on investment. The question needs to change from “does [blank] work?” to “how can I increase the likelihood that [blank] will work for my population?” I hope that our Coalition’s efforts to educate employers and identify and disseminate best practices are helping to answer this question.