Value and the medical home: effects of transformed primary care.
BACKGROUND
The primary care medical home has been promoted to integrate and improve patient care while reducing healthcare spending, but with little formal study of the model or evidence of its efficacy. ProvenHealth Navigator (PHN), an intensive multidimensional medical home model that addresses care delivery and financing, was introduced into 11 different primary care practices. The goals were to improve the quality, efficiency, and patient experience of care.


OBJECTIVE
To evaluate the ability of a medical home model to improve the efficiency of care for Medicare beneficiaries.


METHODS
Observational study using regression modeling based on preintervention and postintervention data and a propensity-selected control cohort.


METHODS
Four years of claims data for Medicare patients at 11 intervention sites and 75 control groups were analyzed to compute hospital admission and readmission rates, and the total cost of care. Regression modeling was used to establish predicted rates and costs in the absence of the intervention. Actual results were compared with predicted results to compute changes attributable to the PHN model.


RESULTS
ProvenHealth Navigator was associated with an 18% (P <.01) cumulative reduction in inpatient admissions and a 36% (P = .02) cumulative reduction in readmissions across the total population over the study period.


CONCLUSIONS
Investing in the capabilities of primary care practices to serve as medical homes may increase healthcare value by improving the efficiency of care. This study demonstrates that the PHN model is capable of significantly reducing admissions and readmissions for Medicare Advantage members.
Gilfillan
Richard J
RJ
Geisinger Health System, Danville, PA, USA. rjgilfil@ptd.net
Tomcavage
Janet
J
Rosenthal
Meredith B
MB
Davis
Duane E
DE
Graham
Jove
J
Roy
Jason A
JA
Pierdon
Steven B
SB
Bloom
Frederick J
FJ
Graf
Thomas R
TR
Goldman
Roy
R
Weikel
Karena M
KM
Hamory
Bruce H
BH
Paulus
Ronald A
RA
Steele
Glen D
GD
D016001:Confidence Intervals; D004526:Efficiency; D017598:Efficiency, Organizational / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D054524:Medicare Part D; D015233:Models, Statistical; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D010414:Pennsylvania; D057216:Propensity Score; D036301:Qualitative Research; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D012044:Regression Analysis; D014481:United States