• Oludolapo A Fakeye, Yea-Jen Hsu, Jonathan P Weiner, and Jill A Marsteller.
• The Hilltop Institute at the University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250. Email: ofakeye@hilltop.umbc.edu.
• Am J Manag Care. 2023 Dec 1; 29 (12): 680686680-686.

ObjectiveTo evaluate the effect of a statewide multipayer patient-centered medical home (PCMH) demonstration on patients consistently within the highest ranks of health services expenditure across Maryland.Study DesignPost hoc longitudinal analyses of administrative data on privately insured patients of medical homes that participated in the Maryland Multi-Payer PCMH Program (MMPP), matched for comparison to medical homes in a single-payer PCMH program and to non-PCMH practices.MethodsConsistently high-cost patients (CHPs) were defined as being in the top statewide quintile of payer expenditure over a 2-year baseline period. Using population-averaged generalized linear regression models, we evaluated the odds of CHPs remaining in the highest-cost quintile during the 2-year MMPP implementation period and assessed changes in their utilization patterns.ResultsSix percent of included patients were CHPs and accounted for one-third of total expenditure. For CHPs in multipayer PCMHs, estimated odds of remaining in this status after 2 years were lower by 34% (adjusted OR [AOR], 0.66; 95% CI, 0.41-0.90; P = .03) relative to CHPs in non-PCMH practices and higher by 41% (AOR, 1.41; 95% CI, 1.08-1.75; P = .004) compared with CHPs in single-payer PCMHs. Relative to CHPs in non-PCMH practices, CHPs in multipayer PCMHs had inpatient admissions decline by 40% (incidence rate ratio [IRR], 0.60; 95% CI, 0.36-1.00; P = .049) and visits to the attributed primary care provider increase by 21% (IRR, 1.21; 95% CI, 1.05-1.39; P = .01).ConclusionsRelative to routine primary care, the PCMH model significantly reduces the probability that CHPs remain in this expensive category and enhances continuity of care.

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