• Martijn van Hasselt, Nancy McCall, Vince Keyes, Suzanne G Wensky, and Kevin W Smith.
• The University of North Carolina at Greensboro, 1400 Spring Garden Street, Greensboro, NC, 27412.
• Health Serv Res. 2015 Feb 1;50(1):253-72.

ObjectiveTo compare health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition.Data SourcesMedicare Part A and B claims files from July 1, 2007 to June 30, 2010, 2009 Census, 2007 Health Resources and Services Administration and CMS Utilization file, Medicare's Enrollment Data Base, and the 2005 American Medical Association Physician Workforce file.Study DesignThis study used a longitudinal, nonexperimental design. Three annual observations (July 1, 2008-June 30, 2010) were available for each practice. We compared selected outcomes between practices with and those without NCQA PCMH recognition.Data Collection MethodsIndividual Medicare fee-for-service (FFS) beneficiaries and their claims and utilization data were assigned to PCMH or comparison practices based on where they received the plurality of evaluation and management services between July 1, 2007 and June 30, 2008.Principal FindingsRelative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices.ConclusionsThis study provides additional evidence about the potential of the PCMH model for reducing health care utilization and the cost of care.© Health Research and Educational Trust.

21 keywords...

hide…