Impact of the Cincinnati Aligning Forces for Quality Multi-Payer Patient Centered Medical Home Pilot on Health Care Quality, Utilization, and Costs

Meredith B Rosenthal; Shehnaz Alidina; Mark W Friedberg; Sara J Singer; Diana Eastman; Zhonghe Li; Eric C Schneider

doi:10.1177/1077558715618566

Impact of the Cincinnati Aligning Forces for Quality Multi-Payer Patient Centered Medical Home Pilot on Health Care Quality, Utilization, and Costs

Med Care Res Rev. 2016 Oct;73(5):532-45. doi: 10.1177/1077558715618566. Epub 2015 Nov 26.

Authors

Meredith B Rosenthal¹, Shehnaz Alidina², Mark W Friedberg³, Sara J Singer⁴, Diana Eastman⁵, Zhonghe Li⁵, Eric C Schneider⁶

Affiliations

¹ Harvard T.H. Chan School of Public Health, Boston, MA, USA mrosenth@hsph.harvard.edu.
² Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA.
³ Brigham and Women's Hospital, Boston, MA, USA RAND Corporation, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
⁴ Harvard T.H. Chan School of Public Health, Boston, MA, USA Harvard Medical School, Boston, MA, USA Massachusetts General Hospital, Boston, MA, USA.
⁵ Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁶ Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA RAND Corporation, Boston, MA, USA Harvard Medical School, Boston, MA, USA.

PMID: 26612180
DOI: 10.1177/1077558715618566

Abstract

To evaluate the potential for a patient-centered medical home initiative to reduce utilization and cost while improving quality, we examined a natural experiment involving 11 primary care practices in Cincinnati, Ohio, that participated in the Aligning Forces for Quality Multi-Payer Patient Centered Medical Home pilot. Our research design involved difference-in-difference analyses, comparing changes in utilization, costs, and quality between patients attributed to pilot practices compared with those attributed to a matched comparison cohort after 2 years of active engagement by the practices. The Cincinnati pilot was associated with a reduction of ambulatory care-sensitive emergency department visits of approximately 0.7 per 1,000 member months or approximately 22.6% (p = .01). While there was a reduction in total costs of care of $7,679 per 1,000 member months, the difference did not reach statistical significance. After 2 years of the pilot, lipid testing in diabetics had increased by 2.7 percentage points (a 3.3% improvement; p < .0001). Patient-centered medical homes have the potential to improve the quality of care and reduce emergency department use but expectations for cost control in a relatively short time horizon and absent other changes may be unrealistic.

Keywords: costs; evaluation; patient-centered medical home; quality; utilization.

MeSH terms

Cohort Studies
Emergency Service, Hospital / statistics & numerical data
Health Care Costs / trends*
Humans
Ohio
Patient-Centered Care* / economics
Patient-Centered Care* / standards
Pilot Projects
Primary Health Care / economics
Primary Health Care / statistics & numerical data*
Quality of Health Care*