TY - JOUR
T1 - Association Between Patient-Centered Medical Home Capabilities and Outcomes for Medicare Beneficiaries Seeking Care from Federally Qualified Health Centers
AU - Timbie, Justin W.
AU - Hussey, Peter S.
AU - Setodji, Claude M.
AU - Kress, Amii
AU - Malsberger, Rosalie
AU - Lavelle, Tara A.
AU - Friedberg, Mark W.
AU - Wensky, Suzanne G.
AU - Giuriceo, Katherine D.
AU - Kahn, Katherine L.
N1 - Funding Information:
The authors thank the participants in the Federally Qualified Health Center Advanced Primary Care Practice Demonstration, Lisa Parker from the Center for Medicare and Medicaid Innovation for feedback on earlier versions of this manuscript, and Monique Martineau from RAND for editorial assistance. The analyses upon which this publication is based were performed under Contract No. HHSM-500-2005-00028I/Task Order HHSM-500-T0008, entitled ?Evaluation of the Federally Qualified Health Center Advanced Primary Care Practice Demonstration,? funded by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. Preliminary results from this study were presented at the 2014 AcademyHealth Annual Research Meeting in San Diego, CA. The authors declare that they do not have a conflict of interest.
Publisher Copyright:
© 2017, Society of General Internal Medicine.
PY - 2017/5/26
Y1 - 2017/5/26
N2 - Background: Patient-centered medical home (PCMH) models of primary care have the potential to expand access, improve population health, and lower costs. Federally qualified health centers (FQHCs) were early adopters of PCMH models. Objective: We measured PCMH capabilities in a diverse nationwide sample of FQHCs and assessed the relationship between PCMH capabilities and Medicare beneficiary outcomes. Design: Cross-sectional, propensity score-weighted, multivariable regression analysis. Participants: A convenience sample of 804 FQHC sites that applied to a nationwide FQHC PCMH initiative and 231,163 Medicare fee-for-service beneficiaries who received a plurality of their primary care services from these sites. Main Measures: PCMH capabilities were self-reported using the National Committee for Quality Assurance’s (NCQA’s) 2011 application for PCMH recognition. Measures of utilization, continuity of care, quality, and Medicare expenditures were derived from Medicare claims covering a 1-year period ending October 2011. Key Results: Nearly 88% of sites were classified as having PCMH capabilities equivalent to NCQA Level 1, 2, or 3 PCMH recognition. These more advanced sites were associated with 228 additional FQHC visits per 1000 Medicare beneficiaries (95% CI: 176, 278), compared with less advanced sites; 0.02 points higher practice-level continuity of care (95% CI: 0.01, 0.03); and a greater likelihood of administering two of four recommended diabetes tests. However, more advanced sites were also associated with 181 additional visits to specialists per 1000 beneficiaries (95% CI: 124, 232) and 64 additional visits to emergency departments (95% CI: 35, 89)—but with no differences in inpatient utilization. More advanced sites had higher Part B expenditures ($111 per beneficiary [95% CI: $61, $158]) and total Medicare expenditures of $353 [95% CI: $65, $614]). Conclusions: Implementation of PCMH models in FQHCs may be associated with improved primary care for Medicare beneficiaries. Expanded access to care, in combination with slower development of key PCMH capabilities, may explain higher Medicare expenditures and other types of utilization.
AB - Background: Patient-centered medical home (PCMH) models of primary care have the potential to expand access, improve population health, and lower costs. Federally qualified health centers (FQHCs) were early adopters of PCMH models. Objective: We measured PCMH capabilities in a diverse nationwide sample of FQHCs and assessed the relationship between PCMH capabilities and Medicare beneficiary outcomes. Design: Cross-sectional, propensity score-weighted, multivariable regression analysis. Participants: A convenience sample of 804 FQHC sites that applied to a nationwide FQHC PCMH initiative and 231,163 Medicare fee-for-service beneficiaries who received a plurality of their primary care services from these sites. Main Measures: PCMH capabilities were self-reported using the National Committee for Quality Assurance’s (NCQA’s) 2011 application for PCMH recognition. Measures of utilization, continuity of care, quality, and Medicare expenditures were derived from Medicare claims covering a 1-year period ending October 2011. Key Results: Nearly 88% of sites were classified as having PCMH capabilities equivalent to NCQA Level 1, 2, or 3 PCMH recognition. These more advanced sites were associated with 228 additional FQHC visits per 1000 Medicare beneficiaries (95% CI: 176, 278), compared with less advanced sites; 0.02 points higher practice-level continuity of care (95% CI: 0.01, 0.03); and a greater likelihood of administering two of four recommended diabetes tests. However, more advanced sites were also associated with 181 additional visits to specialists per 1000 beneficiaries (95% CI: 124, 232) and 64 additional visits to emergency departments (95% CI: 35, 89)—but with no differences in inpatient utilization. More advanced sites had higher Part B expenditures ($111 per beneficiary [95% CI: $61, $158]) and total Medicare expenditures of $353 [95% CI: $65, $614]). Conclusions: Implementation of PCMH models in FQHCs may be associated with improved primary care for Medicare beneficiaries. Expanded access to care, in combination with slower development of key PCMH capabilities, may explain higher Medicare expenditures and other types of utilization.
KW - Medicare
KW - dual eligible
KW - federally qualified health center
KW - patient-centered medical home
KW - quality of care
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U2 - 10.1007/s11606-017-4078-y
DO - 10.1007/s11606-017-4078-y
M3 - Article
C2 - 28550610
AN - SCOPUS:85019675345
VL - 32
SP - 997
EP - 1004
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 9
ER -