PCMHs Have No Effect on Medicaid Patients' Acute Care Use

Marcia Frellick

January 07, 2015

A study of Louisiana primary care clinics that have been certified as patient-centered medical homes (PCMHs) found no effect on acute care use among the Medicaid population and little reduction in cost or primary care use.

Evan S. Cole, PhD, an associate project director at the Georgia Health Policy Center, Georgia State University, Atlanta, and colleagues studied Medicaid claims data from January 1, 2007, through December 31, 2010, obtained from the Louisiana Department of Health and Hospitals. Their findings were reported online January 5 in Health Affairs.

"The findings support a case-mix-adjusted payment policy for medical homes," write the researchers, who suggest that PCMHs may be most effective when they are set up differently, depending on the population they serve. For instance, patients at a pediatric clinic might benefit more from greater access to care, whereas a clinic serving mostly adults might get more benefit from a chronic disease management program.

Authors found that only PCMHs serving populations in which large percentages had chronic illness saw savings, and even that association was weak.

"A per member per month payment policy for patient-centered medical homes might be the most appropriate approach, and it might produce savings only among a subset of clinics. Because of Medicaid's emphasis on children and pregnant women, many clinics that serve Medicaid beneficiaries may have small percentages of chronically ill patients assigned to them and therefore fewer opportunities for significant cost savings," the authors write.

That could present problems for PCMH incentive programs, they note.

Results From PCMH Studies Mixed

PCMHs have received considerable attention for their potential to reduce costs and improve outcomes through better care coordination. But results have been mixed. Many studies have shown that the model reduces emergency department use and leads to improvement in quality measures. But other measures of use, costs, and patient and provider experience have not produced consistently positive results, according to the researchers.

New Orleans, Louisiana, became an early adopter of PCMHs after federal grants for establishing them were made available after Hurricane Katrina.

This study centered on effects on the Medicaid population, which is a large focus area of the Affordable Care Act. Finding out whether PCMHs can improve outcomes for this population is important as states decide whether to expand Medicaid enrollment.

The study has implications for expansion and nonexpansion states, the authors write. Expansion states are enrolling large numbers of patients who have not had insurance for some time and will likely need complex services for multiple chronic diseases. Those states may want to use enrollment to steer patients toward PCMHs.

Nonexpansion states might benefit from establishing PCMHs within their Medicaid programs by focusing on existing elderly, blind, disabled, and other high-need members, the authors say.

Health Aff. Published online January 5, 2015. Abstract

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