Cost evaluation a Medical Home Pilot intervention (Your Doctor Program Medical Home Service)

To reduce medical costs, we must reassess the current US healthcare system, particularly primary care. Even for the insured, the system is fragmented, increasingly costly, difficult to access and navigate, duplicates services, does not connect patients to their care network efficiently, nor assures treatment and prevention guidelines are implemented. The Medical Home model is seen as a key component for reforming care by clinical and payer organizations because of its potential to reduce costs and improve quality of care. We have developed a Medical Home Pilot intervention, the Your Doctor Program Medical Home Service (YDP-MHS). We have been planning the YDP-MHS since 2003. In the YDP-MHS, primary care physicians coordinate patient care with the support of a health information exchange (HIE) system. Since 2005, we have developed an open source health information exchange system that is aligned with the National Health Information Network framework. Since 2008, the system has been tested in a pilot HIE called HealthQuilt. The model and data management process allows physicians to be accessible electronically, coordinate care by reconciling a multi-doctor care plan, and evaluate the quality of the care and data to support that quality evaluation. We are currently implementing the YDP-MHS pilot project and have started the evaluation process. In this presentation, we focus on the healthcare utilization and cost evaluation of the YDP-MHS pilot intervention. Amerigroup, a safety net payor, has agreed to pay a per patient per month fee to UT Physician primary care physician in Houston to participate in the YDP-MHS pilot intervention. Amerigroup identified 500 high cost/high severity patients in their Medicaid program who have a participating UT Physician primary care physician (the treatment group) and 500 patients, matched by age, gender, and severity, who are cared for by other primary care physicians in the Houston area (the control group). We use claims data from Amerigroup to compare clinical outcomes and medical costs in the year before and after the YDP-MHS pilot intervention in the intervention group and the control group. The healthcare utilization outcomes of interest include emergency room visits and preventable hospitalizations. Medical costs are defined as Amerigroup payments for medical care.