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- Title
Impact of the Patient-Centered Medical Home on Consistently High-Cost Patients.
- Authors
Fakeye, Oludolapo A.; Yea-Jen Hsu; Weiner, Jonathan P.; Marsteller, Jill A.
- Abstract
OBJECTIVE: To evaluate the effect of a statewide multipayer patient-centered medical home (PCMH) demonstration on patients consistently within the highest ranks of health services expenditure across Maryland. STUDY DESIGN: Post hoc longitudinal analyses of administrative data on privately insured patients of medical homes that participated in the Maryland Multi-Payer PCMH Program (MMPP), matched for comparison to medical homes in a single-payer PCMH program and to non-PCMH practices. METHODS: Consistently high-cost patients (CHPs) were defined as being in the top statewide quintile of payer expenditure over a 2-year baseline period. Using population-averaged generalized linear regression models, we evaluated the odds of CHPs remaining in the highest-cost quintile during the 2-year MMPP implementation period and assessed changes in their utilization patterns. RESULTS: Six percent of included patients were CHPs and accounted for one-third of total expenditure. For CHPs in multipayer PCMHs, estimated odds of remaining in this status after 2 years were lower by 34% (adjusted OR [AOR], 0.66; 95% CI, 0.41-0.90; P = .03) relative to CHPs in non-PCMH practices and higher by 41% (AOR, 1.41; 95% CI, 1.08-1.75; P = .004) compared with CHPs in single-payer PCMHs. Relative to CHPs in non-PCMH practices, CHPs in multipayer PCMHs had inpatient admissions decline by 40% (incidence rate ratio [IRR], 0.60; 95% CI, 0.36-1.00; P = .049) and visits to the attributed primary care provider increase by 21% (IRR, 1.21; 95% CI, 1.05-1.39; P = .01). CONCLUSIONS: Relative to routine primary care, the PCMH model significantly reduces the probability that CHPs remain in this expensive category and enhances continuity of care.
- Subjects
MARYLAND; FEE for service (Medical fees); STATISTICS; CONFIDENCE intervals; PATIENT-centered care; MEDICAL care costs; MANN Whitney U Test; PRIMARY health care; HEALTH insurance reimbursement; COMPARATIVE studies; CHI-squared test; DESCRIPTIVE statistics; RESEARCH funding; JUDGMENT sampling; ODDS ratio; ALGORITHMS
- Publication
American Journal of Managed Care, 2023, Vol 29, Issue 12, p680
- ISSN
1088-0224
- Publication type
Article
- DOI
10.37765/ajmc.2023.89467