Table 3.
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.
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.
Statistically significant at the 95% confidence level without correction for multiple comparisons.
Statistically significant after correction for multiple comparisons.