Medical homes reduce out-of-pocket costs for special needs children

Families whose special needs children receive services in patient-centered medical homes spend less of their own money on health care, according to a study in the November issue of Pediatrics.

"Families that are flailing around on their own end up spending a lot more," said LeaAnne DeRigne, PhD, one of the study's authors and assistant professor in social work at Florida Atlantic University.

Several studies have indicated that the medical home model lowers overall costs, but this is one of the first to indicate that it saves money for patients, the authors said.

Researchers analyzed data on 31,808 participants of the National Survey of Children with Special Health Care Needs, funded by the Health Resources and Services Administration and the Centers for Disease Control and Prevention. Families spent an average of $317 a year in out-of-pocket expenses to care for a special needs child on public insurance but only $215 if care was provided within the medical home framework.

Families with private insurance paid an average of $1,298 a year, but only $1,088 if the child received care in a medical home. Those without a medical home were more likely to delay care or have unmet medical needs. The authors said care coordination, a central tenet of this model, is resulting in the savings and improved care.

"Costs are higher when you don't have care coordination, and families spend a lot of money on treatments that are not efficacious or cost-effective and on tests that are repeated," said Shirley L. Porterfield, PhD, lead author and associate professor of social work at the University of Missouri in St. Louis.

The medical home model emerged in the late 1960s out of efforts by the American Academy of Pediatrics to improve care for special needs children. About 50% of special needs children are cared for this way, and the model has spread to other populations.

Several medical organizations, including the American Medical Association, have principles defining the patient-centered medical home. A survey of 341 practices by the Medical Group Management Assn., released July 19, found that 67.8% were either becoming a patient-centered medical home or looking to become one.

Many programs coming out of the health system reform law, such as accountable care organizations, are incorporating key aspects of the medical home model.

The Pediatrics study is online (link).