Total Cost of Care Lower among Medicare Fee‐for‐Service Beneficiaries Receiving Care from Patient‐Centered Medical Homes. (31st July 2014)

• Record Type: Journal Article
• Authors: van Hasselt, Martijn; McCall, Nancy; Keyes, Vince; Wensky, Suzanne G.; Smith, Kevin W.
• Is Part Of: Health services research. Volume 50:Number 1(2015:Feb.)
• Page Start: 253
• Page End: 272
• Publication Date: 2014-07-31
• Subjects: Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12217
• Languages: English
• ISSNs: 0017-9124

Abstract

<abstract abstract-type="main" id="hesr12217-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hesr12217-sec-0001" sec-type="section"> <title>Objective</title> <p>To compare health care utilization and payments between NCQA‐recognized patient‐centered medical home (PCMH) practices and practices without such recognition.</p> </sec> <sec id="hesr12217-sec-0002" sec-type="section"> <title>Data Sources</title> <p>Medicare Part A and B claims files from July 1, 2007 to June 30, 2010, 2009 Census, 2007 Health Resources and Services Administration and CMS Utilization file, Medicare's Enrollment Data Base, and the 2005 American Medical Association Physician Workforce file.</p> </sec> <sec id="hesr12217-sec-0003" sec-type="section"> <title>Study Design</title> <p>This study used a longitudinal, nonexperimental design. Three annual observations (July 1, 2008–June 30, 2010) were available for each practice. We compared selected outcomes between practices with and those without NCQA PCMH recognition.</p> </sec> <sec id="hesr12217-sec-0004" sec-type="section"> <title>Data Collection Methods</title> <p>Individual Medicare fee‐for‐service (FFS) beneficiaries and their claims and utilization data were assigned to PCMH or comparison practices based on where they received the plurality of evaluation and management services between July 1, 2007 and June 30, 2008.</p> </sec> <sec id="hesr12217-sec-0005" sec-type="section"> <title>Principal Findings</title> <p>Relative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices.</p> </sec> <sec id="hesr12217-sec-0006" sec-type="section"> <title>Conclusions</title> <p>This study provides additional evidence about the potential of the PCMH model for reducing health care utilization and the cost of care.</p> </sec> </abstract>