title: Patient-centered medical home impact on health plan members with diabetes.
abstract: OBJECTIVE
  To compare costs and utilization for patients with diabetes enrolled in patient-centered medical home (PCMH) practices and non-PCMH practices.
  
  
  METHODS
  Commercial Health Maintenance Organization members with diabetes who enrolled between 2008 and 2011 in 26 Pennsylvania-based PCMH practices that were recognized by the National Committee for Quality Assurance in 2009 were compared with similar patients in 97 non-PCMH primary care practices. A difference-in-differences longitudinal research design was used to analyze differences between both groups on per-member, per-month costs and utilization. The statistical models controlled for baseline practice and patient-level characteristics through 2-step propensity score matching. The regression analysis on program effect further controlled for within-practice variation. Sensitivity analyses were also conducted on patients with type 1 and type 2 diabetes separately, and a third analysis was limited to diabetic patients enrolled in practices within Philadelphia.
  
  
  RESULTS
  Adoption of the PCMH reduced overall medical costs for diabetic patients by 21% in year 1. This reduction was driven largely by inpatient costs, which fell by 44%. Reductions in emergency department visits, outpatient costs, and specialist visits were also seen in subsequent years among patients enrolled in PCMH practices. Additional sensitivity analyses indicated that adoption of the PCMH model yielded similar results when analyzing patients with type 2 diabetes as well as for diabetic patients enrolled in PCMH practices located within the city of Philadelphia.
  
  
  CONCLUSIONS
  The cost of care for patients with diabetes can be reduced by securing care at a PCMH practice. Immediate results were seen in reduction of inpatient costs, which indicate that these patients enrolled in PCMH practices were using less costly inpatient services.
authors.affiliation: Independence Blue Cross, Philadelphia, Pennsylvania.
authors.forename: Qiuyan Cindy
authors.initials: QC
authors.lastname: Wang
authors.forename: Ravi
authors.initials: R
authors.lastname: Chawla
authors.forename: Christine M
authors.initials: CM
authors.lastname: Colombo
authors.forename: Richard L
authors.initials: RL
authors.lastname: Snyder
authors.forename: Somesh
authors.initials: S
authors.lastname: Nigam
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000191:economics*; D010414:Pennsylvania / Q000453:epidemiology; D057216:Propensity Score