Table 4.
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.
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.