title: Pennsylvania's Medical Home Initiative: Reductions in Healthcare Utilization and Cost Among Medicaid Patients with Medicaland Psychiatric Comorbidities.
abstract: The Chronic Care Initiative (CCI) was a large state-wide patient-centered medical home (PCMH) initiative in Pennsylvania in place from 2008-2011.
  
  
  
  Determine whether the CCI impacted the utilization and costs for Medicaid patients with chronic medical conditions and comorbid psychiatric or substance use disorders.
  
  
  
  Analysis of Medicaid claims using difference-in-difference regression analyses to compare changes in utilization and costs for patients treated at CCI practices to propensity score-matched patients treated at comparison non-CCI practices.
  
  
  
  Ninety-six CCI practices in Pennsylvania and 60 non-CCI practices during the same time period.
  
  
  
  A total of 11,105 comorbid Medicaid patients treated in CCI practices and an equal number of propensity-matched comparison patients treated in non-CCI practices.
  
  
  
  Changes in total per-patient costs from 1 year prior to 1 year following an index episode period. Secondary outcomes included utilization and costs for emergency department (ED), inpatient, and outpatient services.
  
  
  
  The CCI group experienced an average adjusted total cost savings of $4145.28 per patient per year (P = 0.023) for the CCI relative to the non-CCI group. This was largely driven by a $3521.15 savings (P = 0.046) in inpatient medical costs, in addition to relative savings in outpatient psychiatric ($21.54, P < 0.001) and substance abuse service costs ($16.42, P = 0.013), compared to the non-CCI group. The CCI group, related to the non-CCI group, had decreases in expected mean counts of ED visits (for those who had any) and psychiatric hospitalizations of 15.6 (95 % CI: -21, -9) and 40.7 (95 % CI: -57, -18) percentage points respectively.
  
  
  
  We do not measure quality of care and cannot make conclusions about the overall cost-effectiveness or long-term effects of the CCI.
  
  
  
  The CCI was associated with substantial cost savings, attributable primarily to reduced inpatient costs, among a high-risk group of Medicaid patients, who may disproportionally benefit from care management in patient-centered medical homes.
authors.affiliation: Office of Population Health Management, Hofstra Northwell Medical School, Emergency Medicine Service Line & Northwell Health Solutions, 200 Community Drive, Great Neck, NY, 11021, USA. krhodes@northwell.edu.
authors.forename: Karin V
authors.initials: KV
authors.lastname: Rhodes
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|The Wharton School of Business, University of Pennsylvania, Philadelphia, PA, USA.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Basseyn
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|West Chester University, West Chester, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gallop
authors.affiliation: University of Pennsylvania School of Social Policy and Practice, Philadelphia, PA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Noll
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.|University of Pennsylvania School of Social Policy and Practice, Philadelphia, PA, USA.
authors.forename: Aileen
authors.initials: A
authors.lastname: Rothbard
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Crits-Christoph
mesh_terms: D015897:Comorbidity; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D010342:Patient Acceptance of Health Care; D018802:Patient-Centered Care / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D010414:Pennsylvania / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology
keywords: Behavioral Health Integration; Health Care Reform; Medicaid Utilization and Costs; Patient-Centered Medical Homes; Pennsylvania Chronic Care Initiative; Physical and Mental Health Co-morbidities