title: Patient-centered medical home cost reductions limited to complex patients.
abstract: OBJECTIVE
  To examine the long-term relationships between costs, utilization, and patient-centered medical home (PCMH) clinical practice systems.
  
  
  METHODS
  Clinical practice systems were evaluated at baseline by the Physician Practice Connections-Research Survey (PPC-RS). Annual costs and utilization of a retrospectively constructed cohort of 58,391 persons receiving primary care at 1 of 22 medical groups over a 5-year period (2005-2009) were compared.
  
  
  METHODS
  Multivariate regressions adjusting for patient demographics, health status, and autoregressive errors compared PPC-RS scores and study outcomes for the entire cohort and 3 subcohorts defined by medical complexity (medication count 0-2 [n = 29,657], 2-6 [n = 19,505], >7 [n = 9229]). Outcomes (adjusted to 2005 dollars) were total costs, outpatient costs, inpatient costs, inpatient days, and emergency department (ED) use.
  
  
  RESULTS
  For the entire cohort, a 10% increase in PPC-RS scores was associated with 3.9 (medication count: 0-2), 6 (3-6), and 11.6 (>7) fewer ED visits per 1000 in 2005; and 5.1, 7.6, and 13.6 fewer ED visits in 2009. That 10% increase was not associated with the 0-2 medication subcohort's total (-$22/person in 2005; $184/person in 2009), outpatient (-$11/person in 2005; $42/person in 2009), or inpatient ($26/person in 2005; $29/person in 2009) costs. However, it was associated with significantly decreased total (-$446/person in 2005; -$184/person in 2009) and outpatient (-$241/person in 2005; -$54/person in 2009) costs for the most medically complex subcohort (>7 medications).
  
  
  CONCLUSIONS
  Association of PCMH clinical practice systems with reduced costs appears limited to the most medically complex patients.
authors.affiliation: HealthPartners Research Foundation, PO Box 1524, MS 21111R, Minneapolis, MN 55440-1524, USA. Thomas.J.Flottemesch@healthpartners.com
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Flottemesch
authors.forename: Louise H
authors.initials: LH
authors.lastname: Anderson
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.forename: Patricia
authors.initials: P
authors.lastname: Fontaine
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Asche
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D008875:Middle Aged; D018803:Models, Economic; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000191:economics; D055553:Prescription Drugs / Q000191:economics; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D012189:Retrospective Studies; D012959:Socioeconomic Factors
chemical_list: D055553:Prescription Drugs