Are Characteristics of the Medical Home Associated With Diabetes Care Costs?

Abstract

Objective To examine the relationship between primary care medical home clinical practice systems (PCMH clinical practice systems) corresponding to the domains of the Chronic Care Model and diabetes-related healthcare costs incurred by members of a health plan who have diagnosed Type 2 diabetes and received care at one of 27 Minnesota-based medical groups over a 12-month period. Study Design Cross-sectional analysis of patient-level cost data in relation to the presence of PCMH clinical practice systems by Chronic Care Model domain using the Physician Practice Connections Readiness Survey (PPC-RS). Methods Multivariate regressions adjusting for patient demographics, health status and comorbidities estimated the relationship between the presence of PCMH clinical practice systems as measured by the PPC-RS and three outcomes: total diabetes-related healthcare costs, ambulatory care management costs, and potentially avoidable costs (e.g. unscheduled inpatient and emergency care). Results Two domains of PCMH clinical practice systems as measured by the PPC-RS were significantly associated with reductions in potentially avoidable costs. These were Health Care Organization (p=.04) and clinical reminder systems in the Decision Support domain (p=.01). Compared to medical groups with only quality improvement, those with improved Health Care Organization defined as performance measurement and individual provider feedback averaged $245/patient less. Similarly, medical groups with clinical reminders for counseling averaged $338/patient less. Conclusions PCMH clinical practice systems that correspond to some domains of the Chronic Care Model are related to reduced inpatient and emergency care costs. Further research is needed about how these systems impact costs over time.

Effectiveness of Diabetes Interventions in the Patient-Centered Medical Home

“…It is not clear whether the PCMH model can lower the cost of care in diabetes populations. Some programs cite cost savings (44, 46–48). The Geisinger group found that medical home members enrolled in their Medical Advantage insurance plan experienced lower costs in proportion to the duration in the medical home, modeling a cost savings of about 7.1% per year (49).…”

Quality improvement collaboratives in the age of health informatics—new wine in new wineskins

“…These data and other recent studies indicate that there is often no clear relationship of higher costs of care with better quality of care. 15 On the contrary, many low-cost clinics had high quality of care.…”

Patient-Centered Medical Home Impact on Health Plan Members With Diabetes

“…7 A recent study used the Physician Practice Connections Readiness Survey to measure the extent of adoption of PCMH characteristics, with greater implementation corresponding to higher scores. 16 Analysis of the survey data indicated that while overall PCMH implementation scores were not associated with reduced costs, scores with respect to subdomains of PCMH implementation ("health care organization" and "clinical decision support") were correlated with lower total and inpatient costs. 16 A systematic review of the PCMH literature to date found that when assessing the results in aggregate, there is moderately strong evidence of an association between PCMH adoption and patient experience and delivery of preventive care, as well as evidence of reduced emergency department utilization among older adults; but there was no consistent evidence of reduced hospitalizations or total cost among patients enrolled in PCMH practices.…”

“…16 Analysis of the survey data indicated that while overall PCMH implementation scores were not associated with reduced costs, scores with respect to subdomains of PCMH implementation ("health care organization" and "clinical decision support") were correlated with lower total and inpatient costs. 16 A systematic review of the PCMH literature to date found that when assessing the results in aggregate, there is moderately strong evidence of an association between PCMH adoption and patient experience and delivery of preventive care, as well as evidence of reduced emergency department utilization among older adults; but there was no consistent evidence of reduced hospitalizations or total cost among patients enrolled in PCMH practices. 17 Because of the often conflicting and inconclusive nature of the existing research of the impact of the PCMH model on cost and quality, this body of work generally acknowledges its limited and preliminary nature and calls for future work on the topic.…”