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Quality of Care and Preventive Screening Use in the CareFirst Patient-Centered Medical Home Program

Kicinger, Iwona M.; Cuellar, Alison; Helmchen, Lorens A.; Gimm, Gilbert; Want, Jay; Kells, Bradley J.; Nichols, Len M.

doi: 10.1097/JHQ.0000000000000169
Original Article

ABSTRACT Despite their value, comprehensive diabetes care and screening for common cancers remain underutilized. We examined the association between participation in a patient-centered medical home (PCMH) program with strong financial incentives and receipt of preventive care in the first 5 years after program launch. Using multivariate regression analysis, we compared outcomes for adults under the care of participating primary care providers (PCPs) with adults under the care of nonparticipating PCPs. Outcomes were breast, cervical and colorectal cancer screenings, and elements of diabetes care. The analytic sample included 818,623 adults living in Maryland, Virginia, or the District of Columbia, and enrolled with CareFirst for at least 1 year during 2010–2015. By Year 5, enrollees in the intervention group were 7.9 (95% confidence interval [CI]: 2.8–13.0), 6.1 (95% CI: 1.4–10.7), 3.1 (95% CI: 2.1–4.0), and 7.6 (95% CI: 7.0–8.2) percentage points more likely to undergo HbA1c tests, nephropathy examinations, breast, and cervical cancer screenings, respectively. We found no significant change in the propensity to receive colorectal cancer screening or an eye examination. Our study shows that a PCMH program with strong financial incentives can raise the provision of preventive care but could require additional adjustment.

For more information on this article, contact Iwona M. Kicinger at

This work was funded by CareFirst BlueCross BlueShield. The authors affirm their independence from the funder in the design and conduct of the research and in the preparation of the manuscript.

Dr. L. M. Nichols discloses receiving speaking honoraria from Baylor Scott and White, Baylor University Medical Center, Comprehensive Family Care Association, Children's Hospital of Colorado, the Colorado Medical Society, Fairview Medical Center, Kansas Association for the Medically Uninsured, ProHealth Medical Group, and America's Health Insurance Plans. Dr. L. M. Nichols is a member of the unpaid Board of Trustees of the National Committee for Quality Assurance, and an unpaid member of the Physician Focused Payment Model Technical Advisory Committee (PTAC), which advises the Secretary of HHS on payment models in the Medicare program. The remaining authors declared no conflict of interest.

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© 2019 National Association for Healthcare Quality
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