PCMH Activities Associated With Slower Growth 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 |
|---|---|---|---|---|
| Registries used to identify patients due for preventive services and patients reminded to schedule these visits | –69.77b,c (P = 0.000) | –36.62b,c (P = 0.000) | –6.78b (P = 0.003) | –11.05b (P = 0.05) |
| Registries used for pre-visit planning, clinician reminders, patient out-reach, and population health monitoring across a comprehensive set of diseases and high-risk patients | –29.31b (P = 0.05) | –11.64 (P = 0.13) | –1.93 (P = 0.21) | –5.49 (P = 0.18) |
| Practice staff, trained in patient education, engage patients with chronic conditions in goal setting and action planning, and ongoing support is available through individualized care or group interventions | –17.75 (P = 0.34) | –14.13 (P = 0.09) | –4.62b (P = 0.01) | –11.53b,c (P = 0.000) |
| The practice monitors patients’ care during hospital and post-acute facility stays, and is involved as needed | –22.56 (P = 0.21) | –22.06b (P = 0.03) | –2.05 (P = 0.20) | –4.99 (P = 0.22) |
| Relationships with commonly referred-to practices (eg, cardiology) are formalized with practice agreements and referral protocols | –16.57 (P = 0.28) | –8.21 (P = 0.25) | –2.10 (P = 0.25) | –11.62b,c (P = 0.000) |
| Quality improvement activities are based on systematic approaches (eg, Plan-Do-Study-Act, tracking performance on quality measures) and used to meet organizational goals | –7.83 (P = 0.71) | –4.17 (P = 0.71) | –0.20 (P = 0.94) | –13.47b,c (P = 0.000) |
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.
↵b Statistically significant at the 95% confidence level without correction for multiple comparisons.
↵c Statistically significant after correction for multiple comparisons.