Total Cost of Care Lower among Medicare Fee-for-Service Beneficiaries Receiving Care from Patient-Centered Medical Homes

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Martijn Van Hasselt, Associate Professor (Creator)
Institution
The University of North Carolina at Greensboro (UNCG )
Web Site: http://library.uncg.edu/

Abstract: Objective. To compare health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition.Data Sources. 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.Study Design. 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.Data Collection Methods. 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.Principal Findings. 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.Conclusions. This study provides additional evidence about the potential of the PCMH model for reducing health care utilization and the cost of care.

Additional Information

Publication
Health Services Research, 50(1), 253–272
Language: English
Date: 2014
Keywords
Patient-centered medical home, Medicare payments, health care utilization

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