Medical home assignment and health service cost/utilization in an indigent population:

Background: Lack of appropriate access to health care is associated with more expensive care and lower health care quality and outcomes. This results partly from the lack of coordination among providers. People without appropriate resources are more likely to visit ER for their medical needs, most of which could be prevented with a regular primary care visit. A Southern California County offered a disease management program that provided health services to selected indigent adults (age 21-64) with diabetes, hypertension, and hyperlipidemia. Primary care in the form of medical home is critical in the current health reform to ensure better access, care quality and reduced cost. Objectives: (1) To describe medical home visit among indigent population in a Southern California County. (2) To investigate the associations between persistent medical home visit and health services utilizations and costs. Data: Eligibility and claims data for participants in the disease management program in a Southern California County were used (2008-2010; n=5,210). Program beneficiaries in this analysis were those who visited no setting to receive primary care other than their assigned medical home. These individuals were defined as “persistent” medical home beneficiaries. The volume and costs of health care services, such as inpatient, outpatient, and ER, were estimated from claims data. Descriptive analysis and multiple regression analysis were performed. Findings: Approximately 71.6% of program participants visited their assigned medical home at least one time during this two year period. However, only 12% visited their medical home “persistently.” After controlling for participant demographic characteristics, those with persistent medical home visit showed 0.6 more admission (p<.00) and higher total inpatient costs of $6,143 (p<.01), when compared to those “non-persistent.” However, inpatient cost per day was lower among those with persistent medical home visit ($1,366 vs. $1,514;p<.04). In addition, a smaller number of ER visit were found among the persistent medical home group (1.6 vs. 2.2;p<.01) but ER cost was lower for the persistent medical home participants, although it was only marginally significant ($407 vs. $520; p<.08). Both number of hospital outpatient visits and cost were significantly lower among the persistent medical home group (1.8 vs. 3.4;p<.04 and $231 vs. $959;p<.00), as were physician office visit (3.1 vs. 8.5 p<.00 and $709 vs. $2,315;p<.00). Conclusion: Medical home assignment may reduce expensive health service utilizations (ER and hospital outpatient visit) and provide an effective way of managing primary care needs if participant are persistently visit their assigned medical homes.