Objectives: To assess baseline quality metrics, healthcare utilization, and costs of commercially insured patients treated at practices participating in a patient-centered medical home (PCMH) pilot.
Study design: Observational cohort study utilizing claims data for patients treated at PCMH and non-PCMH practices.
Methods: Data from Empire Blue Cross and Blue Shield, 1 of 14 plans in the HealthCore Integrated Research Database, were queried for patients identified based on visits to PCMH and non-PCMH practices during 2007-2008; outcome metrics were formulated from the baseline calendar year, 2009. Differences in healthcare utilization were determined with x(2) and 2-sample t tests. Regression models were used to test differences in adjusted emergency department (ED) use, inpatient services, and costs.
Results: The study included 31,032 PCMH and 350,015 non-PCMH patients. Among PCMH-treated patients, diabetics had higher rates of glycated hemoglobin testing; cardiovascular disease patients had higher rates of testing and better low-density lipoprotein cholesterol control; imaging rates for low back pain were lower; among pediatric patients, inappropriate antibiotic use for nonspecific or viral respiratory infections was lower. PCMH-treated adults and children had 12% and 23% lower odds of hospitalization, and required 11% and 17% fewer ED services, respectively, than non-PCMH patients. Risk-adjusted total per member per month costs were 8.6% and 14.5% lower for PCMH-treated pediatric and adult patients, respectively (P <.01).
Conclusions: PCMH practices in this pilot were associated with better preventive health, higher levels of disease management, and lower resource utilization and costs in 2009 compared with practices not pursuing PCMH status.