Objective: To compare costs and utilization for patients with diabetes enrolled in patient-centered medical home (PCMH) practices and non-PCMH practices.
Design: Commercial Health Maintenance Organization members with diabetes who enrolled between 2008 and 2011 in 26 Pennsylvania-based PCMH practices that were recognized by the National Committee for Quality Assurance in 2009 were compared with similar patients in 97 non-PCMH primary care practices. A difference-in-differences longitudinal research design was used to analyze differences between both groups on per-member, per-month costs and utilization. The statistical models controlled for baseline practice and patient-level characteristics through 2-step propensity score matching. The regression analysis on program effect further controlled for within-practice variation. Sensitivity analyses were also conducted on patients with type 1 and type 2 diabetes separately, and a third analysis was limited to diabetic patients enrolled in practices within Philadelphia.
Results: Adoption of the PCMH reduced overall medical costs for diabetic patients by 21% in year 1. This reduction was driven largely by inpatient costs, which fell by 44%. Reductions in emergency department visits, outpatient costs, and specialist visits were also seen in subsequent years among patients enrolled in PCMH practices. Additional sensitivity analyses indicated that adoption of the PCMH model yielded similar results when analyzing patients with type 2 diabetes as well as for diabetic patients enrolled in PCMH practices located within the city of Philadelphia.
Conclusions: The cost of care for patients with diabetes can be reduced by securing care at a PCMH practice. Immediate results were seen in reduction of inpatient costs, which indicate that these patients enrolled in PCMH practices were using less costly inpatient services.
This study aims to add to the growing body of literature evaluating the potential of PCMH transformation by comparing health care costs and utilization among patients with diabetes enrolled in PCMH and non-PCMH practices.
Independence Blue Cross, Philadelphia, Pennsylvania.
Correspondence: Qiuyan Cindy Wang, PhD, Advanced Analytics, Informatics, Independence Blue Cross, 1901 Market St, 19th Floor, Philadelphia, PA 19103 (Cindy.Wang@ibx.com).
This study was funded by Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association. All of the authors were employed by Independence Blue Cross during the course of the study. Dr Nigam was also previously employed at Johnson & Johnson.
The authors thank Susannah Higgins, Jason Neal, Manu Tyagi, Sara Fritz, and Pam Eckardt of Independence Blue Cross, Philadelphia, for their assistance in data collection, analysis, and review. The authors acknowledge the assistance of S2 Statistical Solutions, Inc, Cincinnati, a paid consultant to Independence Blue Cross for their technical support and editing during the manuscript preparation.
Parts of this study were presented in poster form at the 24th National Forum on Quality Improvement in Health Care, Orlando, Florida, December 10-12, 2012 and at the 6th Annual Mid-Atlantic Healthcare Informatics Symposium, Philadelphia, Pennsylvania, April 26, 2013.
The authors declare no conflicts of interest.
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