Role of patient-centered medical home in delivery of more efficient health care

Background: The patient-centered medical home (PCMH) is a current strategy to improve a more efficient use of health care. PCMH requires redesigning delivery of primary care by directing patients towards a primary care provider who focuses on whole patient care and better manages and coordinates patients' health care needs. That PCMH has the potential to address inefficiencies in health care utilization is an agreed upon principal, but what aspects of PCMH are likely to reduce inefficiencies are not as yet quantified. This study examines whether a higher rate of primary care visits leads to reductions in utilization of services. Methods: Enrollment and claims data from enrollees in two counties who participated in the Health Care Coverage Initiative (HCCI) demonstration project were obtained and included one year of pre- and two years of post implementation data. Dependent variables include the annual number of outpatient visits; annual number of those visits that were for evaluation and management; annual number of emergency room visits that resulted in hospitalizations; annual number of emergency room visits that were followed by discharge; annual number of hospitalizations; and the average length of stay. A difference-in-difference approach was used to assess the impact of high rates of visits to PCPs (more than 75%) in the pre and post period. Poisson and negative binomial regressions were used controlling for demographics, health status, and the county of residence. HCCI enrolled adult ages 18-64, with incomes up to 200% of the Federal Poverty Level, legal U.S. citizens and residents were included. A cohort of individuals (N=5,902) with minimum 6 months of pre- and 6 months of post data who received care in each county's safetynet-based network was selected. Results: The analyses revealed that, compared to the pre period, PCP visit rates of greater than 75% in the post period led to a reduction of 21% in annual number of outpatient visits, 18% in annual evaluation and management visits, 47% in emergency room visits followed by hospitalization, 14% in emergency room visits followed by discharge and 52% in repeat hospitalizations. Conclusions: Our findings show a significant and meaningful impact on health care utilization given the greater involvement of PCPs in patient care under the PCMH model, in the population studied. The observed declines in emergency room visits and hospitalizations indicate that many such costly services may be avoided by better use of PCPs in care delivery.