Can the Medical Home Reduce Cancer Morbidity and Mortality?

Wender, Richard C.; Altshuler, Marc

doi:10.1016/j.pop.2009.07.009

Cited by 14 publications

(14 citation statements)

References 27 publications

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“…18 Better monitoring and coordination of survivorship care through primary care medical homes can help reduce additional cancer-related cost burden, lead to earlier detection of Interaction term BCCCP Âurban included. ***P < 0.01, **P < 0.05, *P < 0.1.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 Moreover, medical homes may be useful in improving cancer survivorship care, given that the management of cancer survivors requires coordination of multiple medications, providers, and procedures to ensure optimal cancer follow-up and management of noncancer health care needs. [18][19][20][21] Community Care of North Carolina (CCNC) is an innovative medical home program initiated in the 1990s to enhance primary care case management in vulnerable populations insured by Medicaid. Medicaid patients whose providers are members of one of the CCNC networks throughout the state are enrolled into a CCNC medical home, and their providers and the network receive per member per month payments for care coordination.…”

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confidence: 99%

“…16 The medical homes model in NC, or elsewhere, has not been studied empirically in the context of improving cancer care, although many have proposed using medical home shared-care concepts to coordinate cancer survivorship care. 22,18,20 Capitalizing on NC's use of medical homes for its Medicaid population, the purpose of our research was to examine whether adherence to cancer survivorship guidelines as set forth by the American Society for Clinical Oncology (ASCO) 5 was higher among CCNC enrollees. We focused our efforts on breast cancer because it is one of the most commonly diagnosed malignancies in women 23 and has good prognosis when diagnosed early.…”

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confidence: 99%

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Is Medical Home Enrollment Associated With Receipt of Guideline-Concordant Follow-up Care Among Low-Income Breast Cancer Survivors?

Wheeler

Kohler²,

et al. 2013

Medical Care

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Is Medical Home Enrollment Associated With Receipt of Guideline-Concordant Follow-up Care Among Low-Income Breast Cancer Survivors?

Wheeler

Kohler²,

et al. 2013

Medical Care

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“…In some patient populations, PCMHs have been associated with shorter hospital stays, increased access to needed services, and reduced risks of delayed/forgone care; findings are mixed regarding hospital admissions and emergency department (ED) visits . However, previous research on PCMHs has focused on chronic diseases such as asthma, heart disease, diabetes, and mental illness, and few have examined the potential to improve care among cancer patients and survivors …”

Section: Introductionmentioning

confidence: 99%

“…12,13 However, previous research on PCMHs has focused on chronic diseases such as asthma, heart disease, diabetes, and mental illness, and few have examined the potential to improve care among cancer patients and survivors. 14,15 Follow-up care for cancer patients aligns well with the principles of the PCMH to improve disease management. 15 Cancer treatment and follow-up often entail coordinating multiple providers, procedures, and medications, and over time, continued follow-up and surveillance require additional coordination across providers.…”

Section: Introductionmentioning

confidence: 99%

Association between medical home enrollment and health care utilization and costs among breast cancer patients in a state Medicaid program

Kohler

Lich

et al. 2015

Cancer

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Background The patient centered medical home (PCMH) is increasingly being implemented in an effort to improve and coordinate primary care, but its effect on health care utilization among breast cancer patients remains unclear. The objective of this study was to examine health care utilization and expenditures as a function of PCMH enrollment among breast cancer patients in North Carolina's Medicaid program. Methods North Carolina Medicaid claims linked to North Carolina Central Cancer Registry records (2003-2007) were used to examine monthly patterns of health care use and expenditures. Fixed effects regression models analyzed associations between PCMH enrollment and utilization of outpatient, inpatient, and emergency department (ED) services and Medicaid expenditures during the 15-months after breast cancer diagnosis, controlling for selection bias on time-invariant characteristics. Results Among 758 breast cancer patients, 381 (50%) were enrolled in a PCMH at some time in the 15 months post-diagnosis. After controlling for individual fixed effects, PCMH enrollment was significantly associated with greater outpatient service use, but there was no difference in the probability of inpatient hospitalizations or ED visits. Enrollment in a PCMH was associated with increased average expenditures of $429 per month during the first 15 months. Conclusions Greater outpatient care utilization and increased average expenditures among breast cancer patients enrolled in a PCMH may suggest that these women have improved access to primary and specialty care. Expanding PCMHs may change patterns of service utilization for Medicaid breast cancer patients, but may not be associated with lower costs.

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Changes in chronic medication adherence, costs, and health care use after a cancer diagnosis among low‐income patients and the role of patient‐centered medical homes

Spees

Wheeler

Zhou

et al. 2020

Cancer

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BACKGROUND: Approximately 40% of patients with cancer also have another chronic medical condition. Patient-centered medical homes (PCMHs) have improved outcomes among patients with multiple chronic comorbidities. The authors first evaluated the impact of a cancer diagnosis on chronic medication adherence among patients with Medicaid coverage and, second, whether PCMHs influenced outcomes among patients with cancer. METHODS: Using linked 2004 to 2010 North Carolina cancer registry and claims data, the authors included Medicaid enrollees who were diagnosed with breast, colorectal, or lung cancer who had hyperlipidemia, hypertension, and/or diabetes mellitus. Using difference-indifference methods, the authors examined adherence to chronic disease medications as measured by the change in the percentage of days covered over time among patients with and without cancer. The authors then further evaluated whether PCMH enrollment modified the observed differences between those patients with and without cancer using a differences-indifferences in differences approach. The authors examined changes in health care expenditures and use as secondary outcomes. RESULTS: Patients newly diagnosed with cancer who had hyperlipidemia experienced a 7-percentage point to 11-percentage point decrease in the percentage of days covered compared with patients without cancer. Patients with cancer also experienced significant increases in medical expenditures and hospitalizations compared with noncancer controls. Changes in medication adherence over time between patients with and without cancer were not determined to be statistically significantly different by PCMH status. Some PCMH patients with cancer experienced smaller increases in expenditures (diabetes) and emergency department use (hyperlipidemia) but larger increases in their inpatient hospitalization rates (hypertension) compared with non-PCMH patients with cancer relative to patients without cancer. CONCLUSIONS: PCMHs were not found to be associated with improvements in chronic disease medication adherence, but were associated with lower costs and emergency department visits among some low-income patients with cancer.

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Can the Medical Home Reduce Cancer Morbidity and Mortality?

Cited by 14 publications

References 27 publications

Is Medical Home Enrollment Associated With Receipt of Guideline-Concordant Follow-up Care Among Low-Income Breast Cancer Survivors?

Is Medical Home Enrollment Associated With Receipt of Guideline-Concordant Follow-up Care Among Low-Income Breast Cancer Survivors?

Association between medical home enrollment and health care utilization and costs among breast cancer patients in a state Medicaid program

Changes in chronic medication adherence, costs, and health care use after a cancer diagnosis among low‐income patients and the role of patient‐centered medical homes

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