PCMH Activities Lacking Significant Differences in Spending and Utilization From the Baseline Period to the 3rd Year of the MAPCP Demonstration
| PCMH Activity | Total Health Care Expenditures PBPM ($) | Acute-Care Hospital Expenditures PBPM ($) | All-Cause Hospital Admissions Ratea | ED Visit Ratea |
|---|---|---|---|---|
| Appointment systems have the capacity for walk-ins or same-day visits | 7.34 (P = 0.79) | 5.76 (P = 0.60) | –1.06 (P = 0.64) | 2.24 (P = 0.53) |
| Clinician/practice team has a system to triage patient problems through telephone or e-mail communications or face-to-face visits, with same-day visits usually available | 6.30 (P = 0.82) | –1.37 (P = 0.92) | –0.95 (P = 0.72) | –1.54 (P = 0.73) |
| After-hours access to the practice team for urgent care is available by telephone, and in-person during some evenings or weekends; The practice also coordinates ED care, and follows-up with patients after ED visits | 3.53 (P = 0.80) | –5.49 (P = 0.49) | –0.69 (P = 0.67) | 0.50 (P = 0.90) |
| Alternate types of contact (e-mail, web portal, text message) are used in patient-practice communication, and responses are provided within a timely and consistent timeframe | 7.89 (P = 0.67) | –7.37 (P = 0.44) | –0.48 (P = 0.81) | –7.66 (P = 0.06) |
| Tracking and follow-up with patients for important referrals is consistently done | –8.59 (P = 0.64) | –5.97 (P = 0.50) | 2.21 (P = 0.41) | 0.67 (P = 0.83) |
| Patient referral information to specialists, hospitals, and other medical care providers is consistently transmitted by the practice | 14.09 (P = 0.62) | 5.47 (P = 0.75) | –1.02 (P = 0.62) | 2.66 (P = 0.68) |
| Practices follow up with patients who have been referred to behavioral health supports or community-based resources (eg, social services) | 17.20 (P = 0.26) | 13.83 (P = 0.11) | 0.28 (P = 0.90) | –2.86 (P = 0.46) |
| Follow-up with patients seen in the ED or hospital is done routinely after receiving notification from the ED or hospital | –31.05 (P = 0.16) | –15.03 (P = 0.17) | –1.65 (P = 0.37) | –5.96 (P = 0.11) |
| Visit focus is organized around the reason for a patient’s visit, but with attention to ongoing chronic care and prevention needs | –16.67 (P = 0.42) | –13.93 (P = 0.21) | –1.93 (P = 0.36) | –2.03 (P = 0.58) |
| Medication review for patients on multiple medications is done during care transitions, when patients receive new medications, and during all regularly scheduled visits | 11.51 (P = 0.48) | –1.04 (P = 0.93) | 2.29 (P = 0.21) | 10.03 (P = 0.19) |
| Practice identifies complex patients who may benefit from clinical care management, and actively coordinates their care management with other clinicians and caregivers | –13.48 (P = 0.48) | –2.89 (P = 0.76) | –3.44 (P = 0.12) | –10.14 (P = 0.13) |
| Tracking and follow-up with patients about test results is consistently done for all tests | –9.25 (P = 0.60) | –16.94 (P = 0.09) | –1.51 (P = 0.58) | –5.41 (P = 0.32) |
| Care plans for patients with chronic conditions are recorded in patient medical records, used to guide care, and are given to the patient | –16.53 (P = 0.22) | –9.65 (P = 0.17) | –1.53 (P = 0.31) | –0.64 (P = 0.84) |
| Assessing patient values and preferences (eg, for end-of-life care, role in decision-making) is done for all patients with significant health problems or who articulate values and preferences themselves | –15.92 (P = 0.28) | –10.93 (P = 0.13) | –0.28 (P = 0.85) | –7.12 (P = 0.16) |
| Involving patients in shared decision-making is a priority and systematically done, through clinical decision aids, motivational interviewing, and/or teach-back techniques | 5.17 (P = 0.74) | 7.93 (P = 0.37) | 0.85 (P = 0.65) | –5.54 (P = 0.12) |
| Feedback to the practice from patients is regularly and formally collected (eg, through a patient survey or focus group) and informally (eg, through specific patients’ concerns), and used to improve the practice | 0.46 (P = 0.97) | 2.67 (P = 0.75) | 1.00 (P = 0.63) | –5.31 (P = 0.13) |
ED = emergency department; MAPCP = Multi-Payer Advanced Primary Care Practice; PBPM = per beneficiary per month; PCMH = patient-centered medical home.
Note: A negative value indicates slower growth in spending or utilization among beneficiaries served by practices that engaged in a particular PCMH activity relative to beneficiaries in practices that did not, which is considered a favorable outcome. A positive value indicates faster growth among beneficiaries served by practices that engaged in a particular PCMH activity relative to beneficiaries in practices that did not, which is an unfavorable outcome.
↵a Utilization measures are the number of hospital admissions or the number of emergency department visits not leading to a hospitalization per 1,000 beneficiary quarters.