Document Type
Journal Article
Publication Date
7-2016
Journal
Journal of General Internal Medicine
DOI
10.1007/s11606-016-3814-z
Keywords
patient-centered care; primary care redesign; program evaluation
Abstract
Background
Enhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time.
Objective
To test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits.
Design
We compared medical care expenditures and utilization among adults who participated in the PCMH program to adults who did not participate. We computed difference-in-difference estimates using two-part multivariate generalized linear models for expenditures and negative binomial models for utilization. Control variables included patient demographics, county, chronic condition indicators, and illness severity.
Participants
A total of 1,433,297 adults aged 18–64 years, residing in Maryland, Virginia, and the District of Columbia, and insured by CareFirst for at least 3 consecutive months between 2010 and 2013.
Intervention
CareFirst implemented enhanced fee-for-service payments to the practices, offered a large retrospective bonus if annual cost and quality targets were exceeded, and provided information and care coordination support.
Measures
Outcomes were quarterly claims expenditures per member for all covered services, inpatient care, emergency care, and prescription drugs, and quarterly inpatient admissions and emergency room visits.
Results
By the third intervention year, annual adjusted total claims payments were $109 per participating member (95 % CI: −$192, −$27), or 2.8 % lower than before the program and compared to those who did not participate. Forty-two percent of the overall decline in spending was explained by lower inpatient care, emergency care, and prescription drug spending. Much of the reduction in inpatient and emergency spending was explained by lower utilization of services.
Conclusions
A PCMH model that does not require practices to make infrastructure investments and that rewards cost savings can reduce spending and utilization.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
APA Citation
Cuellar, A., Helmchen, L. A., Gimm, G., Want, J., Burla, S., Kells, B., Kicinger, I., & Nichols, L. M. (2016). The CareFirst Patient-Centered Medical Home Program: Cost and Utilization Effects in Its First Three Years. Journal of General Internal Medicine, (). http://dx.doi.org/10.1007/s11606-016-3814-z
Peer Reviewed
1
Open Access
1
Included in
Health Policy Commons, Health Services Administration Commons, Internal Medicine Commons, Primary Care Commons
Comments
Reproduced with permission of Springer International Publishing. Journal of General Internal Medicine