142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

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

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 9:10 AM - 9:30 AM

Nadereh Pourat, PhD , Department of Health Policy and Management, UCLA Fielding School of Public Health/UCLA Center for Health Policy Research, Los Angeles, CA
Xiao Chen, PhD , UCLA Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA
Max Hadler, MPH, MA , UCLA Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA
Brittany Dixon , UCLA Center for Health Policy Research, UCLA Geffen School of Medicine, Los Angeles, CA
Research Objective: The Affordable Care Act (ACA) has accelerated the adoption of the patient-centered medical home (PCMH) and promoted support for care coordination and integration. These concepts are anticipated to promote the triple aims of ACA by improving quality of care, patients’ health, and reduce costs. This study examines the impact of PCMH recognition and behavioral health integration on service use of enrollees in the Low Income Health Program (LIHP). LIHP was established by a Medicaid 1115 waiver as a bridge to reform and was implemented from January 2011 to December 2013 and was implemented by 53 California counties.

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 prevention
Conduct 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

Presenting author's disclosure statement:

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.