Evaluating Primary Care Renewal in Oregon's Safety Net Clinics: Preliminary Quantitative Findings fr

Authors, Primary Meenan,R.;Mosen,D.;Luke,S.;Perrin,N.
Title Primary Evaluating Primary Care Renewal in Oregon's Safety Net Clinics: Preliminary Quantitative Findings from CareOregon's Adult Medicaid Population
Periodical Full Clinical Medicine & Research Clinical Medicine & Research
Pub Year 2012
Volume 10
issue 3
Start Page 176-177
Abstract Background/Aims The patient-centered medical home (PCMH) holds great promise for improving care delivery. Primary Care Renewal (PCR) is an initiative, launched in early 2007, to transform Oregon safety-net clinics to the PCMH model of care. It is sponsored by CareOregon (CO), a Medicaid/Medicare managed care organization. The primary objective of this study was to conduct a quantitative assessment to identify utilization and cost metrics relevant to PCR practices and to evaluate PCR’s degree of success in improving these metrics. Methods The study population includes CO adult Medicaid enrollees assigned to 17 PCMH clinics (n=11,639) and 280 usual care clinics (n=64,686) over two time periods: 1.18-month pre- implementation period (1/1/2006-6/30/2007) and 2.33-month post-implementation period (1/1/2008-9/30/2010). A six-month break (7/1/2007-12/31/2007) was included as the PCR rollout period. Outcome measures include: 1.hospital days, ED visits, and primary care visits per 1,000 members per year and 2.per member per month (PMPM) medical costs (paid by CO). Utilization and cost information were obtained via claims data. Segmented regression models were used to compare post and pre-implementation periods for each outcome measure. Models were stratified by: 1.adult population (entire population) and 2.Expanded Diagnosis Clusters (EDCs, proxy measure for disease burden). Interactions of level change (post vs. pre-implementation) and clinic type (PCMH vs. non- PCMH) were assessed using segmented regression analysis. Results We found a significant interaction of level change (post vs. pre-implementation) by clinic type for inpatient utilization (beta coefficient = −2.09, p-value = p < .001). Inpatient utilization was significantly lower immediately following implementation than just prior to the implementation. The level change by clinic type interactions were not significant for primary care visits, ED visits and PMPM medical costs. Stratification by EDC for each outcome measure will be completed by the start of the HMORN conference. Discussion Preliminary results suggest PCMH was successful in reducing inpatient utilization after implementation, but no differences were found in other utilization metrics or medical costs. Study results were limited because no clinical quality information was available for analysis. Future research should analyze changes in clinical quality metrics (e.g. HbA1c value) after PCMH interventions are implemented.
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Topic Tag(s) Cost and Reimbursement;Demonstrations;Outcomes;Implementation
Special Population(s) Medicaid Recipients
Case Study Yes
Commentary/Opinion Piece No
Historical Publication No
Key/Foundational Article No
Literature Review No
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