title: Impact of the Cincinnati Aligning Forces for Quality Multi-Payer Patient Centered Medical Home Pilot on Health Care Quality, Utilization, and Costs.
abstract: To evaluate the potential for a patient-centered medical home initiative to reduce utilization and cost while improving quality, we examined a natural experiment involving 11 primary care practices in Cincinnati, Ohio, that participated in the Aligning Forces for Quality Multi-Payer Patient Centered Medical Home pilot. Our research design involved difference-in-difference analyses, comparing changes in utilization, costs, and quality between patients attributed to pilot practices compared with those attributed to a matched comparison cohort after 2 years of active engagement by the practices. The Cincinnati pilot was associated with a reduction of ambulatory care-sensitive emergency department visits of approximately 0.7 per 1,000 member months or approximately 22.6% (p = .01). While there was a reduction in total costs of care of $7,679 per 1,000 member months, the difference did not reach statistical significance. After 2 years of the pilot, lipid testing in diabetics had increased by 2.7 percentage points (a 3.3% improvement; p < .0001). Patient-centered medical homes have the potential to improve the quality of care and reduce emergency department use but expectations for cost control in a relatively short time horizon and absent other changes may be unrealistic.
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA, USA mrosenth@hsph.harvard.edu.
authors.forename: Meredith B
authors.initials: MB
authors.lastname: Rosenthal
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Shehnaz
authors.initials: S
authors.lastname: Alidina
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA RAND Corporation, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Friedberg
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA, USA Harvard Medical School, Boston, MA, USA Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Eastman
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Zhonghe
authors.initials: Z
authors.lastname: Li
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA RAND Corporation, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Schneider
mesh_terms: D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D009820:Ohio; D018802:Patient-Centered Care / Q000191:economics / Q000592:standards; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011787:Quality of Health Care
keywords: costs; evaluation; patient-centered medical home; quality; utilization