304894
Does recognition as patient-centered medical home and behavioral health integration improve care delivery in the safety net? Evidence from early expansion of Medicaid in California
Study Design:We examined enrollment and claims data from the first seven quarters of LIHP. From publicly reported data, we identified the community clinics that were recognized as PCMH and whether they employed behavioral health (BH) providers. We used random effects Poisson models to examine change over time in service use-- number of evaluation and management (E&M) visits, emergency room (ER) visits, and hospitalizations-- by PCMH status, controlling for age, gender, chronic condition and duration of enrollment. We next examined change over time in service use by PCMH status and by employing BH staff for enrollees with BH diagnosis. We calculated the predictive margins for ease of interpretation.
Population Studied:We included LIHP enrollees (total N=48,666 in 37 clinics; had BH diagnosis N=16,847) from 41 participating counties. LIHP eligibility criteria were the same as eligibility for Medicaid under the ACA.
Principal Findings: The adjusted rate of E&M visit (1.3 to 0.9), ER visits (0.19 to 0.15), and hospitalizations (0.09 to 0.04) dropped for PCMH Enrollees from the first quarter to the last quarter. Enrollees with BH diagnosis in PCMH clinics with BH employees experienced the highest drop in adjusted E&M rates (1.59 to 1.24 visits/person). Those with PCMH but no BH employees also experienced a drop by it was less steep and those without PCMH but with BH employees had the least steep drop in rates of E&M.
Conclusions: PCMH recognition significantly reduced the rates of primary care and ER visits and hospitalization during early expansion of Medicaid. BH Integration further reduced primary care visits, but did not have an independent impact from PCMH on ER visits and hospitalization.
Implications for Policy: The findings support the perception that PCMH recognition and BH integration could lead to cost savings. Medicaid programs can garner costs savings by PCMH recognition and BH integration.
Learning Areas:
Chronic disease management and preventionConduct evaluation related to programs, research, and other areas of practice
Public health or related public policy
Learning Objectives:
Describe early implementation of Affordable Care Act in California
Identify potential impact of recognition as a patient-centered medical home on health care use patterns of patients
Discuss advantages of co-location and integration of behavioral health care within the primary care setting
Keyword(s): Affordable Care Act, Patient-Centered Care
Qualified on the content I am responsible for because: I am a senior statistician working on program evaluation projects for more than 2 years. One of the evaluation project was to evaluate California's Low Income Health Program. This presentation is based on our research using the data from this evaluation program.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.