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Partial and Incremental PCMH Practice Transformation: Implications for Quality and Costs
Author(s) -
Paustian Michael L.,
Alexander Jeffrey A.,
El Reda Darline K.,
Wise Chris G.,
Green Lee A.,
Fetters Michael D.
Publication year - 2014
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12085
Subject(s) - medical home , medicine , quality management , population , cohort , health care , quality (philosophy) , confounding , family medicine , primary care , environmental health , operations management , management system , philosophy , epistemology , pathology , economics , economic growth
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 M ichigan. These data were supplemented with contextual data from the Area Resource File. Study Design We measured medical home capabilities in place as of J une 2009 and change in medical home capabilities implemented between J uly 2009 and J une 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 J uly 2009 and J une 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.