title: Patient-centered medical homes in Louisiana had minimal impact on Medicaid population's use of acute care and costs.
abstract: The patient-centered medical home model of primary care has received considerable attention for its potential to improve outcomes and reduce health care costs. Yet little information exists about the model's ability to achieve these goals for Medicaid patients. We sought to evaluate the effect of patient-centered medical home certification of Louisiana primary care clinics on the quality and cost of care over time for a Medicaid population. We used a quasi-experimental pre-post design with a matched control group to assess the effect of medical home certification on outcomes. We found no impact on acute care use and modest support for reduced costs and primary care use among medical homes serving higher proportions of chronically ill patients. These findings provide preliminary results related to the ability of the patient-centered medical home model to improve outcomes for Medicaid beneficiaries. The findings support a case-mix-adjusted payment policy for medical homes going forward.
authors.affiliation: Evan S. Cole (ecole@gsu.edu) is an associate project director at the Georgia Health Policy Center, Georgia State University, in Atlanta.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Cole
authors.affiliation: Claudia Campbell is a professor of health systems management at the School of Public Health and Tropical Medicine, Tulane University, in New Orleans, Louisiana.
authors.forename: Claudia
authors.initials: C
authors.lastname: Campbell
authors.affiliation: Mark L. Diana is an associate professor of health systems management at the School of Public Health and Tropical Medicine, Tulane University.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Diana
authors.affiliation: Larry Webber is a professor of biostatistics at the School of Public Health and Tropical Medicine, Tulane University.
authors.forename: Larry
authors.initials: L
authors.lastname: Webber
authors.affiliation: Richard Culbertson is a professor and director of health policy and systems management in the School of Public Health, Louisiana State University, in New Orleans.
authors.forename: Richard
authors.initials: R
authors.lastname: Culbertson
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002908:Chronic Disease / Q000191:economics* / Q000628:therapy*; D003362:Cost-Benefit Analysis / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D003953:Diagnosis-Related Groups / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D008145:Louisiana; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States; D014600:Utilization Review / Q000639:trends
keywords: Cost of Health Care; Medicaid; Organization and Delivery of Care; Physician Payment; Primary Care