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. 2014 Feb;49(1):52-74.
doi: 10.1111/1475-6773.12085. Epub 2013 Jul 5.

Partial and incremental PCMH practice transformation: implications for quality and costs

Michael L Paustian  1 , Jeffrey A Alexander, Darline K El Reda, Chris G Wise, Lee A Green, Michael D Fetters
Affiliations

Partial and incremental PCMH practice transformation: implications for quality and costs

Michael L Paustian et al. Health Serv Res. 2014 Feb.

Abstract

Objective: To examine the associations between partial and incremental implementation of the Patient Centered Medical Home (PCMH) model and measures of cost and quality of care.

Data source: We combined validated, self-reported PCMH capabilities data with administrative claims data for a diverse statewide population of 2,432 primary care practices in Michigan. These data were supplemented with contextual data from the Area Resource File.

Study design: We measured medical home capabilities in place as of June 2009 and change in medical home capabilities implemented between July 2009 and June 2010. Generalized estimating equations were used to estimate the mean effect of these PCMH measures on total medical costs and quality of care delivered in physician practices between July 2009 and June 2010, while controlling for potential practice, patient cohort, physician organization, and practice environment confounders.

Principal findings: Based on the observed relationships for partial implementation, full implementation of the PCMH model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults. Full PCMH implementation is also associated with a 12.2 percent higher preventive composite score, but no reductions in costs for pediatric populations. Incremental improvements in PCMH model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population.

Conclusions: Estimated effects of the PCMH model on quality and cost of care appear to improve with the degree of PCMH implementation achieved and with incremental improvements in implementation.

Keywords: PCMH; cost; medical home; quality.

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References

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    1. Alexander JA, Wise CG, Green LA, Fetters MD, Mason MH, El Reda DK. Assessment and Measurement of Patient-Centered Medical Home Implementation: the BCBSM Experience. Annals of Family Medicine. 2013;11:S74–81. (Suppl 1): - PMC - PubMed
    1. Area Resource File (ARF) Rockville, MD: US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions; 2010. 2009–2010.
    1. Audet AM, Davis K, Schoenbaum SC. Adoption of Patient-Centered Care Practices by Physicians: Results from a National Survey. Archives of Internal Medicine. 2006;166(7):754–9. - PubMed
    1. Blue Cross Blue Shield of Michigan. BCBSM Physician Group Incentive Program Patient-Centered Medical Home Domains of Function: Interpretive Guidelines. Detroit, MI: Blue Cross Blue Shield of Michigan, Value Partnerships; 2010a. September.

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