Do patient-centered medical homes reduce emergency department visits?

Abstract

Objective: To assess whether adoption of the patient-centered medical home (PCMH) reduces emergency department (ED) utilization among patients with and without chronic illness.

Data sources: Data from approximately 460,000 Independence Blue Cross patients enrolled in 280 primary care practices, all converting to PCMH status between 2008 and 2012.

Research design: We estimate the effect of a practice becoming PCMH-certified on ED visits and costs using a difference-in-differences approach which exploits variation in the timing of PCMH certification, employing either practice or patient fixed effects. We analyzed patients with and without chronic illness across six chronic illness categories.

Principal findings: Among chronically ill patients, transition to PCMH status was associated with 5-8 percent reductions in ED utilization. This finding was robust to a number of specifications, including analyzing avoidable and weekend ED visits alone. The largest reductions in ED visits are concentrated among chronic patients with diabetes and hypertension.

Conclusions: Adoption of the PCMH model was associated with lower ED utilization for chronically ill patients, but not for those without chronic illness. The effectiveness of the PCMH model varies by chronic condition. Analysis of weekend and avoidable ED visits suggests that reductions in ED utilization stem from better management of chronic illness rather than expanding access to primary care clinics.

Keywords: Patient-centered medical home; chronic illness; emergency department.

Figure 1

Cumulative Number of IBC's NCQA-Certified Patient-Centered Medical Homes (PCMHs) between January 2008 and November 2012 Note. The vertical line marks the end of 2011. Our analysis focuses on ED visits and expenditures between 2008 and 2011, but it includes patients in all practices reaching PCMH status between 2008 and 2012, including 95 practices that received NCQA certification during 2012, when incentive payments from IBC changed.