Impact of the Cincinnati Aligning Forces for Quality Multi-Payer Patient Centered Medical Home Pilot on Health Care Quality, Utilization, and Costs. (October 2016)

• Record Type: Journal Article
• Authors: Rosenthal, Meredith B.; Alidina, Shehnaz; Friedberg, Mark W.; Singer, Sara J.; Eastman, Diana; Li, Zhonghe; Schneider, Eric C.
• Is Part Of: Medical care research and review. Volume 73:Number 5(2016:Oct.)
• Page Start: 532
• Page End: 545
• Publication Date: 2016-10
• Subjects: patient-centered medical home -- evaluation -- quality -- utilization -- costs; Medical care -- United States -- Periodicals; Medical care -- Periodicals; Medical care -- Research -- United States -- Periodicals; Medical care -- Research -- Periodicals; Medical economics -- United States -- Periodicals; Medical economics -- Periodicals; 362.10973
• DOI: 10.1177/1077558715618566
• Languages: English
• ISSNs: 1077-5587

Abstract

To evaluate the potential for a patient-centered medical home initiative to reduce utilization and cost while improving quality, we examined a natural experiment involving 11 primary care practices in Cincinnati, Ohio, that participated in the Aligning Forces for Quality Multi-Payer Patient Centered Medical Home pilot. Our research design involved difference-in-difference analyses, comparing changes in utilization, costs, and quality between patients attributed to pilot practices compared with those attributed to a matched comparison cohort after 2 years of active engagement by the practices. The Cincinnati pilot was associated with a reduction of ambulatory care–sensitive emergency department visits of approximately 0.7 per 1, 000 member months or approximately 22.6% ( p = .01). While there was a reduction in total costs of care of $7, 679 per 1, 000 member months, the difference did not reach statistical significance. After 2 years of the pilot, lipid testing in diabetics had increased by 2.7 percentage points (a 3.3% improvement; p < .0001). Patient-centered medical homes have the potential to improve the quality of care and reduce emergency department use but expectations for cost control in a relatively short time horizon and absent other changes may be unrealistic.