title: The impact of electronic health records on ambulatory costs among Medicaid beneficiaries.
abstract: BACKGROUND
  Broad adoption of electronic health records (EHRs) is a potential strategy for curbing healthcare cost growth, which is particularly vital for Medicaid. Despite limited evidence for EHR-related cost savings, the 2009 HITECH Act included incentives for providers to become meaningful users of EHRs. We evaluated a large Massachusetts EHR pilot to obtain early insight into the potential for the national strategy to reduce short-run healthcare costs in the Medicaid population.
  
  
  METHODS
  We calculated monthly ambulatory cost and visit measures from Medicaid claims data for beneficiaries receiving the majority of their care in the three Massachusetts eHealth Collaborative (MAeHC) pilot communities or in six matched control communities. Using a difference-in-differences of slope analysis, we assessed whether cost and visit trajectories differed in the pre-implementation period compared to the post-implementation period for intervention and control community members.
  
  
  RESULTS
  We found evidence that EHR adoption impacted ambulatory medical cost in two of the three communities, but the effects were in opposite directions. Ambulatory medical costs increased more slowly in one intervention compared to its control communities in the pre-to-post period (difference-in-differences=-1.98%, p<0.001; PMPM savings of $41.60). In contrast, for a second pilot community, ambulatory medical cost increased more slowly in the control communities (difference-in-differences=2.56%, p=0.005; PMPM increase of $43.34).
  
  
  CONCLUSIONS
  As a stand-alone approach, adoption of commercially-available EHRs in community practices did not consistently impact Medicaid costs in the short-run. This suggests that future meaningful use criteria may need to specifically target cost savings and coordinate with payment reform efforts.
authors.affiliation: University of Michigan.
authors.forename: Julia
authors.initials: J
authors.lastname: Adler-Milstein
authors.affiliation: Partners HealthCare.
authors.forename: Claudia
authors.initials: C
authors.lastname: Salzberg
authors.affiliation: Eastern Research Group.
authors.forename: Calvin
authors.initials: C
authors.lastname: Franz
authors.affiliation: Partners HealthCare.
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.affiliation: Partners HealthCare.
authors.forename: David Westfall
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics* / Q000458:organization & administration; D017046:Cost Savings / Q000379:methods / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000458:organization & administration; D014481:United States
keywords: Health Care Costs; Health Policy / Politics / Law / Regulation; Information Technology in Health; Medicaid
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