Patient-Centered Medical Home Activities Associated With Low Medicare Spending and Utilization
| Autor: | Susan G. Haber, Stephen Zuckerman, Vincent Keyes, Rachel Burton |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Medical home medicine.medical_specialty Quality management Referral Medicare 03 medical and health sciences 0302 clinical medicine Patient-Centered Care Humans Medicine 030212 general & internal medicine Referral and Consultation Aged Original Research Aged 80 and over Patient registry business.industry Fee-for-Service Plans Emergency department Patient Acceptance of Health Care United States Hospitalization Action planning Family medicine Regression Analysis Female Health Expenditures Emergency Service Hospital Family Practice business Medicaid Facilities and Services Utilization Patient centered |
| Zdroj: | Ann Fam Med |
| ISSN: | 1544-1717 1544-1709 |
| DOI: | 10.1370/afm.2589 |
| Popis: | PURPOSE To identify components of the patient-centered medical home (PCMH) model of care that are associated with lower spending and utilization among Medicare beneficiaries. METHODS Regression analyses of changes in outcomes for Medicare beneficiaries in practices that engaged in particular PCMH activities compared with beneficiaries in practices that did not. We analyzed claims for 302,719 Medicare fee-for-service beneficiaries linked to PCMH surveys completed by 394 practices in the Centers for Medicare & Medicaid Services’ 8-state Multi-Payer Advanced Primary Care Practice demonstration. RESULTS Six activities were associated with lower spending or utilization. Use of a registry to identify and remind patients due for preventive services was associated with all 4 of our outcome measures: total spending was $69.77 less per beneficiary per month (PBPM) (P = 0.00); acute-care hospital spending was $36.62 less PBPM (P = 0.00); there were 6.78 fewer hospital admissions per 1,000 beneficiaries per quarter (P1KBPQ) (P = 0.003); and 11.05 fewer emergency department (ED) visits P1KBPQ (P = 0.05). Using a patient registry for pre-visit planning and clinician reminders was associated with $29.31 lower total spending PBPM (P = 0.05). Engaging patients with chronic conditions in goal setting and action planning was associated with 4.62 fewer hospital admissions P1KBPQ (P = 0.01) and 11.53 fewer ED visits P1KBPQ (P = 0.00). Monitoring patients during hospital stays was associated with $22.06 lower hospital spending PBPM (P = 0.03). Developing referral protocols with commonly referred-to clinicians was associated with 11.62 fewer ED visits P1KBPQ (P = 0.00). Using quality improvement approaches was associated with 13.47 fewer ED visits P1KBPQ (P =0.00). CONCLUSIONS Practices seeking to deliver more efficient care may benefit from implementing these 6 activities. |
| Databáze: | OpenAIRE |
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