Study: Pediatric Patients Benefit From PCMH Utilization

Based on a recent research from the Children’s Hospital in Colorado, researchers argue that public funding efforts should be invested in improving the use of patient centered medical homes (PCMH) for children covered under public insurance, or those who have no insurance at all.

According to the research, led by James Todd, MD, the Jules Amer Chair in Community Pediatrics at the Children's Hospital in Colorado, the number of children who were covered by public insurance in Colorado has almost doubled since 2008. The researchers suggest that children are more likely to lack access to consistent primary care than children covered by private insurance.

The study analyzed trends in Colorado’s emergency department (ED) and hospital utilization rates related to children between 2014 and 2015. The researchers found that children in Colorado with public or no insurance were 2.4 times more likely to be hospitalized, and 4.8 times more likely to visit EDs compared to privately insured children. According to the findings, taxpayers in Colorado could have saved $214,000,000 in Medicaid payments if care was delivered in a PCMH instead of a hospital.

Furthermore, the researchers determined that families with public or no health insurance often visit primary care, urgent care, EDs, and hospital care in different ways than those with private insurance. Often times these families are more likely to visit EDs for illnesses that can be effectively managed by a same or next day primary care visit. Additionally, researchers suggest that their higher hospitalization rates may be a result of illnesses progressing to a more serious level due to a delay in seeking care.

The researchers recommended three key strategies to optimize PCMH utilization, including offering easy patient access 24/7 with pediatric-focused health management, extending office hours for acute primary care, and ensuring comprehensive, continuous care coordination.

“The research findings imply that, if publicly insured and uninsured children had access to - and appropriately utilized - a medical home, many emergency department visits could be prevented, resulting in lower costs to public insurers,” Dr Todd said in a press release. “This is especially pertinent given the current state of health care because reductions in primary care reimbursement rates locally and possible changes in health care financing nationally will likely do the opposite and further increase emergency department and hospitalization costs.”

—Julie Gould (Mazurkiewicz)