The Impact of Rhode Island's Multipayer Patient-centered Medical Home Program on Utilization and Cost of Care.
Med Care
; 57(10): 801-808, 2019 10.
Article
em En
| MEDLINE
| ID: mdl-31464841
ABSTRACT
OBJECTIVE:
To estimate the effect of patient-centered medical home (PCMH) participation on cost and utilization of care for patients in Rhode Island's statewide, multipayer PCMH program, which serves over one-third of the state population. DATA SOURCES/STUDYSETTING:
2009-2014 claims data from all payers in Rhode Island, representing >743,000 unique patients. STUDYDESIGN:
A propensity score-matched difference-in-differences framework was used to separately estimate the effect of the PCMH on 3 patient cohorts, which were defined by their intervention start dates and amounts of implementation time. Outcomes included patient costs (total, inpatient, outpatient, professional, pharmacy) and utilization [emergency department (ED) visits, preventable ED visits, inpatient admissions, preventable inpatient admissions, all-cause 30-day readmissions]. Interaction effects were estimated to assess heterogeneity among clinical risk groups and payers. PRINCIPALFINDINGS:
There was no evidence of a PCMH effect on total costs, though we observed evidence of an increase in the odds of PCMH patients having outpatient and professional costs, and in one cohort, a decrease in inpatient costs for those with an inpatient visit. We also observed evidence of reduced ED visits, preventable ED visits, and inpatient admissions for PCMH patients. While subgroup effects varied by cohort and measure, high-risk patients often experienced the largest reductions in ED visits.CONCLUSIONS:
All PCMH cohorts experienced statistically significant reductions in some types of utilization in as little as 1.25 years. Reductions were greatest for measures included in the PCMH contractual agreement. While PCMH programs may not expect cost savings in the short-term, costs could potentially be reduced in the longer-term through avoided ED and inpatient expenses.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Custos de Cuidados de Saúde
/
Assistência Centrada no Paciente
/
Utilização de Instalações e Serviços
/
Reembolso de Seguro de Saúde
Tipo de estudo:
Evaluation_studies
/
Health_economic_evaluation
/
Sysrev_observational_studies
Limite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Med Care
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Marrocos