title: Initial Impacts of the Patient Care Networks of Alabama Initiative.
abstract: OBJECTIVE
  To estimate the effects of medical home support on the use of clinical services and Medicaid expenditures.
  
  
  METHODS
  Medicaid claims.
  
  
  METHODS
  A difference-in-differences model where changes in utilization and expenditures of the intervention group are compared to changes in the nonintervention group.
  
  
  METHODS
  Using Medicaid claims from October 2010 through September 2013, service use and expenditures are measured for 12 months before and 21 months after implementation. Changes for four health status groups are examined separately.
  
  
  RESULTS
  The introduction of community-based support was associated with a small reduction in use and no statistically significant overall effect on expenditures. However, among those with chronic and/or mental health conditions, there were modest, statistically significant increases in use of and expenditures for a range of ambulatory and inpatient health care services, while service use for those without these conditions declined. Emergency department use increased for all groups.
  
  
  CONCLUSIONS
  Community-based support for medical home practices is associated with a shift in the service mix provided to higher cost, more vulnerable subgroups in Medicaid. Such systems are unlikely to be associated with significant overall cost savings, at least in the short term, but may have other benefits.
authors.affiliation: School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Bronstein
authors.affiliation: Texas A&M University, College Station, TX.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Morrisey
authors.affiliation: School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Bisakha
authors.initials: B
authors.lastname: Sen
authors.affiliation: School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Sally
authors.initials: S
authors.lastname: Engler
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Wilson K
authors.initials: WK
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid; D001523:Mental Disorders / Q000191:economics; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D017059:Models, Econometric; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D010820:Physicians / Q000191:economics / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000191:economics; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
chemical_list: D055553:Prescription Drugs
keywords: Managed care techniques (e.g., utilization review); Medicaid; chronic disease; managed care organizations (e.g., HMOs/PPOs/IPAs); state health policies