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Med Care Res Rev. 2016 Oct;73(5):532-45. doi: 10.1177/1077558715618566. Epub 2015 Nov 26.

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

Author information

1
Harvard T.H. Chan School of Public Health, Boston, MA, USA mrosenth@hsph.harvard.edu.
2
Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA.
3
Brigham and Women's Hospital, Boston, MA, USA RAND Corporation, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
4
Harvard T.H. Chan School of Public Health, Boston, MA, USA Harvard Medical School, Boston, MA, USA Massachusetts General Hospital, Boston, MA, USA.
5
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
6
Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA RAND Corporation, Boston, MA, USA Harvard Medical School, Boston, MA, USA.

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.

KEYWORDS:

costs; evaluation; patient-centered medical home; quality; utilization

PMID:
26612180
DOI:
10.1177/1077558715618566
[Indexed for MEDLINE]

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