Spending Differences Associated With the Medicare Physician Group Practice Demonstration

Colla, Carrie H.; Wennberg, David E.; Meara, Ellen; Skinner, Jonathan; Gottlieb, Daniel J.; Lewis, Valerie A.; Snyder, Christopher; Fisher, Elliott S.

doi:10.1001/2012.jama.10812

Cited by 142 publications

(114 citation statements)

References 23 publications

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“…High rates of 30-day readmission may also indicate poor integration of the health care delivery system, one in which care is poorly coordinated across settings. 16,17 Similarly, post-discharge emergency department visits, which account for about 40% of all acute post-discharge care encounters 8 and contribute a meaningful share of hospital spending, 1,18 have also been proposed as a novel marker of inadequate care coordination. 7,8,18 A portion of all-cause hospital readmissions and post-discharge emergency department visits are deemed preventable.…”

mentioning

confidence: 99%

Team-based versus traditional primary care models and short-term outcomes after hospital discharge

Riverin

Naimi

et al. 2017

CMAJ

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confidence: 99%

Team-based versus traditional primary care models and short-term outcomes after hospital discharge

Riverin

Naimi

et al. 2017

CMAJ

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“…Rather, high-risk patients with multiple comorbidities are the most logical targets for interventions." 19 Similar trends have also been seen in other care delivery models, such as the Medicare's Physician Group Practice Demonstration 52,53 and some Accountable Care demonstrations, 54 which found differential reductions in cost among patients with chronic illness compared to all patients. Although we did not directly compare utilization/cost of high- risk (medical/psychiatric comorbid) and non-high-risk patients, the cost savings suggest that PCMHs could strengthen their emphasis on this population by allocating training/ monitoring of behavioral health integration to achieve both optimal care and cost reductions.…”

Section: Discussionmentioning

confidence: 65%

Pennsylvania’s Medical Home Initiative: Reductions in Healthcare Utilization and Cost Among Medicaid Patients with Medicaland Psychiatric Comorbidities

et al. 2016

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BACKGROUND:The Chronic Care Initiative (CCI) was a large state-wide patient-centered medical home (PCMH) initiative in Pennsylvania in place from [2008][2009][2010][2011]. OBJECTIVE: Determine whether the CCI impacted the utilization and costs for Medicaid patients with chronic medical conditions and comorbid psychiatric or substance use disorders. DESIGN: Analysis of Medicaid claims using difference-indifference regression analyses to compare changes in utilization and costs for patients treated at CCI practices to propensity score-matched patients treated at comparison non-CCI practices. SETTING: Ninety-six CCI practices in Pennsylvania and 60 non-CCI practices during the same time period. PARTICIPANTS: A total of 11,105 comorbid Medicaid patients treated in CCI practices and an equal number of propensity-matched comparison patients treated in non-CCI practices. MEASUREMENTS: Changes in total per-patient costs from 1 year prior to 1 year following an index episode period. Secondary outcomes included utilization and costs for emergency department (ED), inpatient, and outpatient services. RESULTS: The CCI group experienced an average adjusted total cost savings of $4145.28 per patient per year (P = 0.023) for the CCI relative to the non-CCI group. This was largely driven by a $3521.15 savings (P = 0.046) in inpatient medical costs, in addition to relative savings in outpatient psychiatric ($21.54, P < 0.001) and substance abuse service costs ($16.42, P = 0.013), compared to the non-CCI group. The CCI group, related to the non-CCI group, had decreases in expected mean counts of ED visits (for those who had any) and psychiatric hospitalizations of 15.6 (95 % CI: -21, −9) and 40.7 (95 % CI: -57, -18) percentage points respectively. LIMITATIONS: We do not measure quality of care and cannot make conclusions about the overall costeffectiveness or long-term effects of the CCI. CONCLUSIONS: The CCI was associated with substantial cost savings, attributable primarily to reduced inpatient costs, among a high-risk group of Medicaid patients, who may disproportionally benefit from care management in patient-centered medical homes.

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“…In a number of instances, the savings are realized through lower utilization and a less expensive service mix, such as the shift from inpatient care to outpatient visits, as well as the use of generic drugs over brand names. Although ACOs and ACO-like arrangements have produced savings, the results are not always consistent (e.g., Kocot et al 2014;Colla et al 2012). Moreover, there is a concern that provider consolidation may lead to higher prices, potentially increasing the impact of medical-specific inflation on expenditure growth (Health Care Cost Institute 2014; Baker et al 2014;Robinson 2011;Berenson et al 2010).…”

Section: Innovations With the Potential To Reduce The Rate Of Health mentioning

confidence: 99%

Forecasts and Drivers of Health Expenditure Growth in California

Fulton¹,

Scheffler²,

Keolanui³

et al. 2015

CJPP

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California's state government, employers, and households are concerned about the future affordability of healthcare. We use health expenditure data from the Centers for Medicare & Medicaid Services' Office of the Actuary to forecast California's health expenditures from 2013 to 2022 and identify factors driving expenditure increases. Real health expenditures per capita (2013$) are forecasted to increase from $8,398 to $11,421 (or 36 percent), resulting in health expenditures increasing from 14.5 percent to 16.0 percent of California's economy. Expenditure increases are mostly driven by gains in real income per capita (40-60 percent), followed by medical-specific inflation (23 percent), an aging population (14 percent), and insurance coverage gains (8 percent). The -4 percent to 16 percent residual is attributable to changes in the volume and mix of services and technology. Several innovations could potentially dampen these increases, such as shared-risk, value-based payment models, practice redesign initiatives, lower cost settings and healthcare professionals, many of which are found in accountable care organizations.

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Spending Differences Associated With the Medicare Physician Group Practice Demonstration

Cited by 142 publications

References 23 publications

Team-based versus traditional primary care models and short-term outcomes after hospital discharge

Team-based versus traditional primary care models and short-term outcomes after hospital discharge

Pennsylvania’s Medical Home Initiative: Reductions in Healthcare Utilization and Cost Among Medicaid Patients with Medicaland Psychiatric Comorbidities

Forecasts and Drivers of Health Expenditure Growth in California

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