Patient-Centered Medical Home Cost Reductions Limited to Complex Patients

Authors, Primary Flottemesch,Thomas, J.;Anderson,Louise, H.;Solberg,Leif, I.;Fontaine,Patricia;Asche,Stephen, E.
Title Primary Patient-Centered Medical Home Cost Reductions Limited to Complex Patients
Periodical Full American Journal of Managed Care
Pub Year 2012
Volume 18
issue 11
Start Page 677-686
Abstract Objectives: To examine the long-term relationships between costs, utilization, and patient- centered medical home (PCMH) clinical practice systems. Study Design: Clinical practice systems were evaluated at baseline by the Physician Practice Connections-Research Survey (PPC-RS). Annual costs and utilization of a retrospectively constructed cohort of 58,391 persons receiving primary care at 1 of 22 medical groups over a 5-year period (2005-2009) were compared. Methods: Multivariate regressions adjusting for patient demographics, health status, and autoregressive errors compared PPC-RS scores and study outcomes for the entire cohort and 3 subcohorts defined by medical complexity (medication count 0-2 n = 29,657], 2-6 n = 19,505], ≥7 n = 9229]). Outcomes (adjusted to 2005 dollars) were total costs, outpatient costs, inpatient costs, inpatient days, and emergency department (ED) use. Results: For the entire cohort, a 10% increase in PPC-RS scores was associated with 3.9 (medication count: 0-2), 6 (3-6), and 11.6 (a7) fewer ED visits per 1000 in 2005; and 5.1, 7.6, and 13.6 fewer ED visits in 2009.That 10% increase was not associated with the 0-2 medication subcohort's total (-$22/person in 2005; $184/person in 2009), outpatient (-S11/person in 2005; $42/person in 2009), or inpatient ($26/person in 2005; $29/per- son in 2009) costs. However, it was associated with significantly decreased total (-$446/person in 2005; -$184/person in 2009) and outpatient (-$241/person in 2005; -$54/person in 2009) costs for the most medically complex subcohort (≥>7 medications). Conclusions: Association of PCMH clinical practice systems with reduced costs appears limited to the most medically complex patients.
Publisher Not Available
Place of Publication Not Available
Author/Address HealthPartners Research Foundation, Minneapolis MN
PubMed Link
Reference Type(s) Journal Article
Topic Tag(s) Cost and Reimbursement;Outcomes
Special Population(s) Not Available
Case Study No
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