Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care.
Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by -$482 relative to the comparison (95% CI, -$573 to -$391; P < .001). The lower costs were driven primarily by inpatient (-$218; P < .001) and outpatient hospital expenditures (-$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196-205).
1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont.
Craig
C
Jones
2 Onpoint Health Data , Portland, Maine.
Karl
K
Finison
2 Onpoint Health Data , Portland, Maine.
Katharine
K
McGraves-Lloyd
1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont.
Timothy
T
Tremblay
1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont.
Mary Kate
MK
Mohlman
1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont.
Beth
B
Tanzman
1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont.
Miki
M
Hazard
1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont.
Steven
S
Maier
1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont.
Jenney
J
Samuelson
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D008875:Middle Aged; D018802:Patient-Centered Care / Q000191:economics*; D011787:Quality of Health Care; D014707:Vermont; D055815:Young Adult