title: Patient-centered medical home initiative produced modest economic results for Veterans Health Administration, 2010-12.
abstract: In 2010 the Veterans Health Administration (VHA) began a nationwide initiative called Patient Aligned Care Teams (PACT) that reorganized care at all VHA primary care clinics in accordance with the patient-centered medical home model. We analyzed data for fiscal years 2003-12 to assess how trends in health care use and costs changed after the implementation of PACT. We found that PACT was associated with modest increases in primary care visits and with modest decreases in both hospitalizations for ambulatory care-sensitive conditions and outpatient visits with mental health specialists. We estimated that these changes avoided $596 million in costs, compared to the investment in PACT of $774 million, for a potential net loss of $178 million in the study period. Although PACT has not generated a positive return, it is still maturing, and trends in costs and use are favorable. Adopting patient-centered care does not appear to have been a major financial risk for the VHA.
authors.affiliation: Paul L. Hebert (paul.hebert2@va.gov) is an investigator in the Veterans Affairs (VA) Health Services Research and Development Center for Veteran-Centered, Value-Driven Health, VA Puget Sound Health Care System, and a research associate professor in the Department of Health Services, School of Public Health, University of Washington, both in Seattle.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hebert
authors.affiliation: Chuan-Fen Liu is an investigator in the VA Health Services Research and Development Center for Veteran-Centered, Value-Driven Health and a research professor in the Department of Health Services, School of Public Health, University of Washington.
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
authors.affiliation: Edwin S. Wong is an investigator in the VA Health Services Research and Development Center for Veteran-Centered, Value-Driven Health.
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Wong
authors.affiliation: Susan E. Hernandez is a doctoral candidate in the Department of Health Services, School of Public Health, University of Washington.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hernandez
authors.affiliation: Adam Batten is a statistician in the VA Health Services Research and Development Center for Veteran-Centered, Value-Driven Health.
authors.forename: Adam
authors.initials: A
authors.lastname: Batten
authors.affiliation: Sophie Lo is a program analyst in the Veterans Health Administration Office of Analytics and Business Intelligence, in Bedford, Massachusetts.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lo
authors.affiliation: Jaclyn M. Lemon is a medical student at the University of Washington School of Medicine.
authors.forename: Jaclyn M
authors.initials: JM
authors.lastname: Lemon
authors.affiliation: Douglas A. Conrad is a professor of health services at the School of Public Health, University of Washington.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Conrad
authors.affiliation: David Grembowski is a professor of health services at the University of Washington.
authors.forename: David
authors.initials: D
authors.lastname: Grembowski
authors.affiliation: Karin Nelson is an investigator in the VA Health Services Research and Development Center for Veteran-Centered, Value-Driven Health and an associate professor in the Department of Medicine, School of Medicine, University of Washington.
authors.forename: Karin
authors.initials: K
authors.lastname: Nelson
authors.affiliation: Stephan D. Fihn is director of the VHA Office of Analytics and Business Intelligence, VA Puget Sound Health Care System, and a professor in the Department of Medicine, School of Medicine, University of Washington.
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008875:Middle Aged; D010346:Patient Care Management / Q000191:economics / Q000458:organization & administration; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D018802:Patient-Centered Care / Q000191:economics* / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics* / Q000458:organization & administration*
keywords: Access To Care; Health Spending; Organization and Delivery of Care