title: Partial and incremental PCMH practice transformation: implications for quality and costs.
abstract: OBJECTIVE
  To examine the associations between partial and incremental implementation of the Patient Centered Medical Home (PCMH) model and measures of cost and quality of care.
  
  
  METHODS
  We combined validated, self-reported PCMH capabilities data with administrative claims data for a diverse statewide population of 2,432 primary care practices in Michigan. These data were supplemented with contextual data from the Area Resource File.
  
  
  METHODS
  We measured medical home capabilities in place as of June 2009 and change in medical home capabilities implemented between July 2009 and June 2010. Generalized estimating equations were used to estimate the mean effect of these PCMH measures on total medical costs and quality of care delivered in physician practices between July 2009 and June 2010, while controlling for potential practice, patient cohort, physician organization, and practice environment confounders.
  
  
  RESULTS
  Based on the observed relationships for partial implementation, full implementation of the PCMH model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults. Full PCMH implementation is also associated with a 12.2 percent higher preventive composite score, but no reductions in costs for pediatric populations. Incremental improvements in PCMH model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population.
  
  
  CONCLUSIONS
  Estimated effects of the PCMH model on quality and cost of care appear to improve with the degree of PCMH implementation achieved and with incremental improvements in implementation.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Blue Cross Blue Shield of Michigan, Ann Arbor, MI.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Paustian
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alexander
authors.forename: Darline K
authors.initials: DK
authors.lastname: El Reda
authors.forename: Chris G
authors.initials: CG
authors.lastname: Wise
authors.forename: Lee A
authors.initials: LA
authors.lastname: Green
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fetters
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D008824:Michigan; D017146:Models, Organizational; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000191:economics* / Q000592:standards*; D011320:Primary Health Care / Q000191:economics* / Q000592:standards*; D011787:Quality of Health Care / Q000191:economics*; D014481:United States
keywords: PCMH; cost; medical home; quality