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Reynolds JC, Damiano PC, Herndon JB. Patient centered dental home: Building a framework for dental quality measurement and improvement. J Public Health Dent 2021; 82:445-452. [PMID: 34704254 DOI: 10.1111/jphd.12482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/18/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This article presents results of the second phase of a project to develop a patient-centered dental home (PCDH) model. Aims of PCDH model development include broadening the scope of prior dental home definitions to include populations across the lifespan, developing a quality measurement framework to facilitate quality assessment and improvement, and promoting opportunities for medical-dental integration through alignment with existing PCMH models. This phase determined the components, or conceptual subdivisions, associated with a previously developed PCDH definition and characteristics. METHODS We used a modified Delphi process to obtain structured feedback and gain consensus among the project national advisory committee (NAC). The process included a web-based survey that asked NAC members to rank the importance of each potential component on a scale of 1-9. Criteria for consensus on component inclusion/exclusion combined a median rating and measure of disagreement. Respondents were also encouraged to provide open-ended feedback regarding rationale for component ratings and additional suggested components. RESULTS A total of 47 out of 51 members completed the survey. All 34 components met the quantitative criteria for inclusion in the PCDH model. Changes were made to components based on open-ended feedback. CONCLUSIONS This project phase further developed a PCDH measurement framework that aims to guide practice transformation, quality measurement and improvement in dental care delivery, as well as integration between medicine and dentistry. Using a Delphi approach with a broad group of stakeholders ensured that components had face validity and were conceptually aligned with the PCDH definition and characteristics.
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Affiliation(s)
- Julie C Reynolds
- College of Dentistry, University of Iowa, Iowa City, Iowa, USA.,Public Policy Center, University of Iowa, Iowa City, Iowa, USA
| | - Peter C Damiano
- College of Dentistry, University of Iowa, Iowa City, Iowa, USA.,Public Policy Center, University of Iowa, Iowa City, Iowa, USA
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Fakeye OA, Khanna N, Hsu YJ, Marsteller JA. Impact of a Statewide Multi-Payer Patient-Centered Medical Home Program on Antihypertensive Medication Adherence. Popul Health Manag 2021; 25:309-316. [PMID: 34609933 DOI: 10.1089/pop.2021.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Evidence suggests that the patient-centered medical home (PCMH) model of primary care improves management of chronic disease, but there is limited research contrasting this model's effect when financed by a single payer versus multiple payers, and among patients with different types of health insurance. This study evaluates the impact of a statewide medical home demonstration, the Maryland Multi-Payer PCMH Program (MMPP), on adherence to antihypertensive medication therapy relative to non-PCMH primary care and to the PCMH model when financed by a single payer. The authors used a difference-in-differences analytic design to analyze changes in medication possession ratio for antihypertensive medications among Medicaid-insured and privately insured non-elderly adult patients attributed to primary care practices in the MMPP ("multi-payer PCMHs"), medical homes in Maryland that participated in a regional PCMH program funded by a single private payer ("single-payer PCMHs"), and non-PCMH practices in Maryland. Comparison sites were matched to multi-payer PCMHs using propensity scores based on practice characteristics, location, and aggregated provider characteristics. Multi-payer PCMHs performed better on antihypertensive medication adherence for both Medicaid-insured and privately insured patients relative to single-payer PCMHs. Statistically significant effects were not observed consistently until the second year of the demonstration. There were negligible differences in outcome trends between multi-payer medical homes and matched non-PCMH practices. Findings indicate that health care delivery innovations may yield superior population health outcomes under multi-payer financing compared to when such initiatives are financed by a single payer.
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Affiliation(s)
- Oludolapo A Fakeye
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Niharika Khanna
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jill A Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Swietek KE, Gaynes BN, Jackson GL, Weinberger M, Domino ME. Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care. J Gen Intern Med 2020; 35:2304-2313. [PMID: 32096075 PMCID: PMC7403275 DOI: 10.1007/s11606-020-05729-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/23/2019] [Accepted: 02/10/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Research demonstrates that the patient-centered medical home (PCMH) is associated with improved clinical outcomes and quality of care, and the populations that can most benefit from this model require long-term management, e.g., persons with chronic illness and behavioral health conditions. However, different populations may not benefit equally from the PCMH, and empirical evidence about the effects of this model on racial disparities is limited. OBJECTIVE Estimate the association between enrollment in National Committee for Quality Assurance (NCQA)-recognized PCMHs and racial disparities in quality of care for adults with major depressive disorder (MDD) and comorbid medical conditions. DESIGN Applying a quasi-experimental instrumental variable design to account for differential selection into the PCMH, we used generalized estimating equations to determine the probability of receiving eight disease-specific quality measures. SUBJECTS Medicaid enrollees in three states not dually enrolled in Medicare, ages 18-64 with MDD and > 1 other chronic condition. A subgroup analysis was conducted for enrollees with comorbid diabetes. INTERVENTIONS Enrollment in an NCQA-recognized PCMH. MAIN MEASURES Disease-specific quality indicators for MDD (e.g., antidepressant use, receipt of psychotherapy), and for diabetes, (e.g. A1c testing, LDL-C testing, retinal exams, and medical attention for nephropathy). KEY RESULTS PCMH enrollment was associated with an increase in the overall likelihood of receiving six of eight recommended services and a decrease in the likelihood of receiving any psychotherapy (4.94 percentage points, p < 0.01) and retinal exams (5.51 percentage points, p < 0.05). Although both groups improved, PCMH enrollment was associated with an exacerbation of the Black-white disparity in adequate antidepressant use by 4.20 percentage points (p < 0.01). CONCLUSIONS While PCMH enrollment may improve the overall quality of care, the effect is inconsistent across racial groups and not always associated with reductions in racial disparities in quality.
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Affiliation(s)
- Karen E Swietek
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- NORC at the University of Chicago, Chicago, IL, USA.
| | - Bradley N Gaynes
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marisa Elena Domino
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA
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Gregg A, Chen LW, Kim J. Correlates of Patient-Centered Medical Home Recognition in School-Based Health Centers. THE JOURNAL OF SCHOOL HEALTH 2018; 88:830-838. [PMID: 30300927 DOI: 10.1111/josh.12689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/14/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The patient-centered medical home (PCMH) is promoted as a way to improve access to care, health care outcomes, and control costs. The organizational, environmental, and patient characteristics associated with school-based health centers (SBHCs) obtaining PCMH recognition is currently unknown. A multitheoretical approach was used to explore the correlates of formal PCMH recognition in SBHCs. METHODS The 2013-2014 National Census of School-Based Health Centers was used as the primary data source for this analysis. Multivariable logistic regression was used to assess the odds of an SBHC obtaining any type of PCMH recognition, and obtaining national PCMH recognition. RESULTS Only 29% of SBHCs had received any type of recognition as a PCMH and 17% reported receiving national-level recognition. School-based health centers that were managed care preferred providers, received Health Resources and Services Administration SBHC Capital Funding, and based in schools without adolescents had greater odds of both types of PCMH recognition outcomes. High levels of revenue from patient billing and more staff were also associated with national PCMH recognition. CONCLUSIONS Financial and personnel resources are needed for national-level PCMH recognition, and managed care is supportive of PCMH implementation. Efforts should be made to increase medical home activity in SBHCs that serve adolescents.
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Affiliation(s)
- Abbey Gregg
- Department of Community Medicine and Population Health, Institute for Rural Health Research, The University of Alabama University of Alabama, 1127 Northeast Medical Building, Tuscaloosa, AL 35487
| | - Li-Wu Chen
- Department of Health Services Research and Administration, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE 68198-4350
| | - Jungyoon Kim
- Department of Health Services Research and Administration, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE 68198-4350
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Gilmer TP, Avery M, Siantz E, Henwood BF, Center K, Pomerance E, Sayles J. Evaluation Of The Behavioral Health Integration And Complex Care Initiative In Medi-Cal. Health Aff (Millwood) 2018; 37:1442-1449. [DOI: 10.1377/hlthaff.2018.0372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Todd P. Gilmer
- Todd P. Gilmer is a professor in the Department of Family Medicine and Public Health, University of California San Diego (UCSD), in La Jolla
| | - Marc Avery
- Marc Avery is a clinical professor of psychiatry and behavioral sciences at the University of Washington, in Seattle
| | - Elizabeth Siantz
- Elizabeth Siantz is a postdoctoral scholar in the Department of Family Medicine and Public Health, UCSD
| | - Benjamin F. Henwood
- Benjamin F. Henwood is an associate professor in the School of Social Work, University of Southern California, in Los Angeles
| | - Kimberly Center
- Kimberly Center is a research associate in the Department of Family Medicine and Public Health, UCSD
| | - Elise Pomerance
- Elise Pomerance is senior medical director of practice transformation at the Inland Empire Health Plan, in Rancho Cucamonga, California
| | - Jennifer Sayles
- Jennifer Sayles is chief medical officer at the Inland Empire Health Plan
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Advantages and Disadvantages of the Patient-Centered Medical Home: A Critical Analysis and Lessons Learned. Health Care Manag (Frederick) 2018; 36:357-363. [PMID: 28961641 DOI: 10.1097/hcm.0000000000000178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article provides a detailed examination of the pros and cons associated with patient-centered medical homes (PCMHs). Opinions and findings from those who have studied PCMHs and those who have been directly involved with this type of health care model are outlined. Key lessons from providers are detailed, and critical success factors are highlighted. This synthesized analysis serves to lend evidence to health care managers and providers who are considering implementation of the PCMH model.
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Expanding the Capacity of Primary Care to Treat Co-morbidities in Children with Autism Spectrum Disorder. J Autism Dev Disord 2018; 48:4222-4230. [DOI: 10.1007/s10803-018-3630-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Sabik LM, Dahman B, Vichare A, Bradley CJ. Breast and Cervical Cancer Screening Among Medicaid Beneficiaries: The Role of Physician Payment and Managed Care. Med Care Res Rev 2018; 77:34-45. [PMID: 29726303 DOI: 10.1177/1077558718771123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Medicaid-insured women have low rates of cancer screening. There are multiple policy levers that may influence access to preventive services such as screening, including physician payment and managed care. We examine the relationship between each of these factors and breast and cervical cancer screening among nonelderly nondisabled adult Medicaid enrollees. We combine individual-level data on Medicaid enrollment, demographics, and use of screening services from the Medicaid Analytic eXtract files with data on states' Medicaid-to-Medicare fee ratios and estimate their impact on screening services. Higher physician fees are associated with greater screening for comprehensive managed care enrollees; for enrollees in fee-for-service Medicaid, the findings are mixed. Patient participation in primary care case management is a significant moderator of the relationship between physician fees and the rate of screening, as interactions between enrollee primary care case management status and the Medicaid fee ratio are consistently positive across models of screening.
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Marsteller JA, Hsu YJ, Gill C, Kiptanui Z, Fakeye OA, Engineer LD, Perlmutter D, Khanna N, Rattinger GB, Nichols D, Harris I. Maryland Multipayor Patient-centered Medical Home Program: A 4-Year Quasiexperimental Evaluation of Quality, Utilization, Patient Satisfaction, and Provider Perceptions. Med Care 2018; 56:308-320. [PMID: 29462077 PMCID: PMC5882272 DOI: 10.1097/mlr.0000000000000881] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate impact of the Maryland Multipayor Patient-centered Medical Home Program (MMPP) on: (1) quality, utilization, and costs of care; (2) beneficiaries' experiences and satisfaction with care; and (3) perceptions of providers. DESIGN 4-year quasiexperimental design with a difference-in-differences analytic approach to compare changes in outcomes between MMPP practices and propensity score-matched comparisons; pre-post design for patient-reported outcomes among MMPP beneficiaries. SUBJECTS Beneficiaries (Medicaid-insured and privately insured) and providers in 52 MMPP practices and 104 matched comparisons in Maryland. INTERVENTION Participating practices received unconditional financial support and coaching to facilitate functioning as medical homes, membership in a learning collaborative to promote education and dissemination of best practices, and performance-based payments. MEASURES Sixteen quality, 20 utilization, and 13 cost measures from administrative data; patient-reported outcomes on care delivery, trust in provider, access to care, and chronic illness management; and provider perceptions of team operation, team culture, satisfaction with care provided, and patient-centered medical home transformation. RESULTS The MMPP had mixed impact on site-level quality and utilization measures. Participation was significantly associated with lower inpatient and outpatient payments in the first year among privately insured beneficiaries, and for the entire duration among Medicaid beneficiaries. There was indication that MMPP practices shifted responsibility for certain administrative tasks from clinicians to medical assistants or care managers. The program had limited effect on measures of patient satisfaction (although response rates were low) and on provider perceptions. CONCLUSIONS The MMPP demonstrated mixed results of its impact and indicated differential program effects for privately insured and Medicaid beneficiaries.
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Affiliation(s)
- Jill A. Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | | | | | - Oludolapo A. Fakeye
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Lilly D. Engineer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | | | - Niharika Khanna
- Department of Family and Community Medicine (NK), University of Maryland School of Medicine, Baltimore, MD
| | - Gail B. Rattinger
- Department of Health Outcomes and Administrative Sciences (GBR), Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY
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Jones AL, Cochran SD, Leibowitz A, Wells KB, Kominski G, Mays VM. Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010-2015. Healthcare (Basel) 2018; 6:healthcare6020029. [PMID: 29565323 PMCID: PMC6023347 DOI: 10.3390/healthcare6020029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/10/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022] Open
Abstract
Background. Black and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, we used a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. Methods. Data were obtained from the Medical Expenditures Panel Survey (MEPS), a two-year panel study of healthcare use, satisfaction with care, and costs of services in the United States (US). We pooled data from six waves (14–19) of participants with serious psychological distress to examine racial, ethnic, and nativity disparities in medical and mental health visits to primary care (PC) and specialty mental health (SMH) providers around the time of ACA reforms, 2010–2015. Results. Of the 2747 respondents with serious psychological distress, 1316 were non-Latino White, 632 non-Latino Black, 532 identified as Latino with Mexican, Central American, or South American (MCS) origins, and 267 as Latino with Caribbean island origins; 525 were foreign/island born. All racial/ethnic groups were less likely than non-Latino Whites to have any PC visit. Of those who used PC, non-Latino Blacks were less likely than Whites to have a PC mental health visit, while foreign born MCS Latinos were less likely to visit an SMH provider. Conditional on any mental health visit, Latinos from the Caribbean were more likely than non-Latino Whites to visit SMH providers versus PC providers only, while non-Latino Blacks and US born MCS Latinos received fewer PC mental health visits than non-Latino Whites. Conclusion. Racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
| | - Susan D Cochran
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), CA 90095, USA.
- Department of Statistics, University of California, Los Angeles, CA 90095, USA.
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA 90095, USA.
| | - Arleen Leibowitz
- UCLA Luskin School of Public Affairs, Los Angeles, CA 90095, USA.
| | - Kenneth B Wells
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.
- UCLA Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, USA.
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
| | - Gerald Kominski
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
- UCLA Center for Health Policy Research, Los Angeles, CA 90024, USA.
| | - Vickie M Mays
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA 90095, USA.
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
- Department of Psychology, University of California, Los Angeles, CA 90095, USA.
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Jones AL, Thomas R, Hedayati DO, Saba SK, Conley J, Gordon AJ. Patient predictors and utilization of health services within a medical home for homeless persons. Subst Abus 2018; 39:354-360. [PMID: 29412071 DOI: 10.1080/08897077.2018.1437500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Veterans Health Administration (VHA) established a patient-centered medical home model of care for veterans experiencing homelessness called a Homeless Patient Aligned Care Team (HPACT) to improve engagement with primary care and reduce utilization of hospital-based services. To evaluate the impact of the HPACT model, this study compares the number and type of health care visits in the 12 months before and after enrollment in HPACT at one VHA facility, and explores patient characteristics associated with increases and decreases in visits. METHODS Chart reviews of VHA medical records were conducted for all patients enrolled in an HPACT in Pittsburgh, Pennsylvania, between May 2012 and December 2013 (N = 179). Multivariable mixed-effect logistic regressions estimated differences in having any visit in the 0-6 months and 7-12 months before and after HPACT enrollment, and multinomial logistic regressions predicted increases or decreases versus no change in number of visits over 12 months. RESULTS Compared with 0-6 months prior to HPACT, patients were more likely to visit primary care in the 0-6 months (adjusted odds ratio [aOR] = 4.91, 95% confidence interval [CI] = 2.94-8.20) and 7-12 months (aOR = 2.30, 95% CI = 1.42-3.72) following HPACT. Patients were less likely to visit the emergency department (ED) or to be hospitalized in the 0-6 months (aOR = 0.57, 95% CI = 0.34-0.94; and aOR = 0.55, 95% CI = 0.25-0.76) and 7-12 months (aOR = 0.43, 95% CI = 0.33-0.91; and aOR = 0.45, 95% CI = 0.26-0.80) following HPACT. Patients were less likely to visit mental health (aOR = 0.35, 95% CI = 0.20-0.60) and addiction specialists (aOR = 0.39, 95% CI = 0.18-0.84) in the 7-12 months following HPACT. Overall, 59% of patients had increases in primary care visits following HPACT. Female patients and those with self-housing were less likely to have increases versus no change in primary care visits (adjusted relative risk ratio [aRRR] = 0.15, 95% CI = 0.03-0.74; and aRRR = 0.35, 95% CI = 0.14-0.90). CONCLUSIONS An integrated HPACT model was successful in engaging homeless veterans in primary care for 1 year, potentially contributing to reductions in ED use. More tailored approaches may be needed for vulnerable populations experiencing homelessness, including homeless women.
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Affiliation(s)
- Audrey L Jones
- a Informatics , Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center of Innovation, VA Salt Lake City Health Care System , Salt Lake City , Utah , USA.,b Department of Internal Medicine , University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Roxanne Thomas
- c Providence Milwaukie Hospital , Milwaukie , Oregon , USA
| | | | - Shaddy K Saba
- e Center for Health Equity Research and Promotion (CHERP) , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | - James Conley
- e Center for Health Equity Research and Promotion (CHERP) , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | - Adam J Gordon
- a Informatics , Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center of Innovation, VA Salt Lake City Health Care System , Salt Lake City , Utah , USA.,b Department of Internal Medicine , University of Utah School of Medicine , Salt Lake City , Utah , USA.,f Department of Psychiatry , University of Utah School of Medicine , Salt Lake City , Utah , USA
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Gajewski JL, McClellan MB, Majhail NS, Hari PN, Bredeson CN, Maziarz RT, LeMaistre CF, Lill MC, Farnia SH, Komanduri KV, Boo MJ. Payment and Care for Hematopoietic Cell Transplantation Patients: Toward a Specialized Medical Home for Complex Care Patients. Biol Blood Marrow Transplant 2017; 24:4-12. [PMID: 28963077 DOI: 10.1016/j.bbmt.2017.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/20/2017] [Indexed: 12/15/2022]
Abstract
Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time. Payment is linked to quality measures, including proportion of care delivered according to predefined pathways and demonstrated impact on outcomes. Some medical homes also include opportunities for shared savings by reducing overall costs of care. Recent proposals have suggested expanding the medical home model to specialized populations with complex needs because primary care teams may not have the facilities or the requisite expertise for their unique needs. An example of a successful care model that may provide valuable lessons for those creating specialty medical home models already exists in many hematopoietic cell transplantation (HCT) centers that deliver multidisciplinary, coordinated, and highly specialized care. The integration of care delivery in HCT centers has been driven by the specialty care their patients require and by the payment methodology preferred by the commercial payers, which has included bundling of both inpatient and outpatient care in the peritransplant interval. Commercial payers identify qualified HCT centers based on accreditation status and comparative performance, enabled in part by center-level comparative performance data available within a national outcomes database mandated by the Stem Cell Therapeutic and Research Act of 2005. Standardization across centers has been facilitated via voluntary accreditation implemented by Foundation for the Accreditation of Cell Therapy. Payers have built on these community-established programs and use public outcomes and program accreditation as standards necessary for inclusion in specialty care networks and contracts. Although HCT centers have not been described as medical homes, most HCT providers have already developed the structures that address critical requirements of MACRA for medical homes.
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Affiliation(s)
- James L Gajewski
- Department of Health Policy and Strategic Relations, American Society for Blood and Marrow Transplantation, Chicago, Illinois.
| | - Mark B McClellan
- Duke University Margolis Center for Health Policy, Durham, North Carolina
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Division of Hematology & Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Richard T Maziarz
- Stem Cell Transplantation Program, Division of Hematology & Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Michael C Lill
- Stem Cell and Bone Marrow Transplant Program, Division of Hematology and Medical Oncology, Samuel Oschin Comprehensive Cancer Center, Los Angeles, California
| | - Stephanie H Farnia
- Department of Health Policy and Strategic Relations, American Society for Blood and Marrow Transplantation, Chicago, Illinois
| | - Krishna V Komanduri
- Adult Hematopoietic Stem Cell Transplant Program, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Michael J Boo
- National Marrow Donor Program, Minneapolis, Minnesota
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Hausmann LR, Canamucio A, Gao S, Jones AL, Keddem S, Long JA, Werner R. Racial and Ethnic Minority Concentration in Veterans Affairs Facilities and Delivery of Patient-Centered Primary Care. Popul Health Manag 2017; 20:189-198. [DOI: 10.1089/pop.2016.0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Leslie R.M. Hausmann
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion (CHERP), Pittsburgh, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anne Canamucio
- Veterans Integrated Service Network 4 Center to Evaluate Patient Aligned Care Teams (CEPACT), Philadelphia, Pennsylvania
| | - Shasha Gao
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion (CHERP), Pittsburgh, Pennsylvania
| | - Audrey L. Jones
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion (CHERP), Pittsburgh, Pennsylvania
| | - Shimrit Keddem
- Veterans Integrated Service Network 4 Center to Evaluate Patient Aligned Care Teams (CEPACT), Philadelphia, Pennsylvania
| | - Judith A. Long
- Veterans Integrated Service Network 4 Center to Evaluate Patient Aligned Care Teams (CEPACT), Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Center for Health Equity Research and Promotion (CHERP), Philadelphia, Pennsylvania
- Divison of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel Werner
- Veterans Integrated Service Network 4 Center to Evaluate Patient Aligned Care Teams (CEPACT), Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Center for Health Equity Research and Promotion (CHERP), Philadelphia, Pennsylvania
- Divison of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Webster SM. Children and young people in out-of-home care: canaries in the coal mine of healthcare commissioning. Aust J Prim Health 2017; 22:15-21. [PMID: 26455264 DOI: 10.1071/py15040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 08/26/2015] [Indexed: 11/23/2022]
Abstract
Australian Primary Health Networks could pioneer local health service reform for children and young people living in out-of-home care. Significant maltreatment, the leading cause of placement of 0-17-year-olds under the protective canopy of foster, kinship and residential care (described collectively as out-of-home care) left more than 50000 children vulnerable to poor health outcomes in 2013-14. Opportunistic health care is inadequate to meet the chronic and complex health needs of maltreated children. This article reviews some critical lessons from English commissioning and US healthcare marketplace reforms in an attempt to better meet the needs of children and young people in out-of-home care. It identifies key questions that Australian Primary Health Networks would need to resolve if they were to follow overseas trends and adopt health service commissioning as a means to provide more effective and efficient health care for this at-risk population.
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Affiliation(s)
- Susan M Webster
- Department of General Practice, Melbourne Medical School, University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia. Email
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15
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Takach M, Townley C, Yalowich R, Kinsler S. Making multipayer reform work: what can be learned from medical home initiatives. Health Aff (Millwood) 2016; 34:662-72. [PMID: 25847650 DOI: 10.1377/hlthaff.2014.1083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Multipayer collaboratives of all types will encounter legal, logistical, and often political obstacles that multipayer medical home initiatives have already overcome. The seventeen multipayer medical home initiatives launched between 2008 and 2014 all navigated four critical decision-making points: convening stakeholders; establishing provider participation criteria; determining payment; and measuring performance. Although we observed trends toward voluntary payer participation and more flexible participation criteria for both payers and providers, initiatives continue to vary widely, each shaped largely by its insurance market and policy environment. Medical home initiatives across the United States are demonstrating that multipayer reform, although complex and difficult to implement, is feasible when committed stakeholders negotiate strategies that are responsive to the local context. Their experiences can inform, and perhaps expedite, negotiations in current and future multipayer collaborations.
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Affiliation(s)
- Mary Takach
- Mary Takach is a senior program director at the National Academy for State Health Policy (NASHP) in Portland, Maine
| | | | | | - Sarah Kinsler
- Sarah Kinsler is a health policy analyst at the Department of Vermont Health Access, in Montpelier. At the time this article was written, she was a policy specialist at NASHP
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16
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Edwards ST, Bitton A, Hong J, Landon BE. Patient-centered medical home initiatives expanded in 2009-13: providers, patients, and payment incentives increased. Health Aff (Millwood) 2016; 33:1823-31. [PMID: 25288429 DOI: 10.1377/hlthaff.2014.0351] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patient-centered medical home initiatives are central to many efforts to reform the US health care delivery system. To better understand the extent and nature of these initiatives, in 2013 we performed a nationwide cross-sectional survey of initiatives that included payment reform incentives in their models, and we compared the results to those of a similar survey we conducted in 2009. We found that the number of initiatives featuring payment reform incentives had increased from 26 in 2009 to 114 in 2013. The number of patients covered by these initiatives had increased from nearly five million to almost twenty-one million. We also found that the proportion of time-limited initiatives--those with a planned end date--was 20 percent in 2013, a decrease from 77 percent in 2009. Finally, we found that the dominant payment model for patient-centered medical homes remained fee-for-service payments augmented by per member per month payments and pay-for-performance bonuses. However, those payments and bonuses were higher in 2013 than they were in 2009, and the use of shared-savings models was greater. The patient-centered medical home model is likely to continue both to become more common and to play an important role in delivery system reform.
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Affiliation(s)
- Samuel T Edwards
- Samuel T. Edwards is a fellow at the Veterans Affairs Boston Healthcare System and Harvard Medical School, both in Boston, Massachusetts
| | - Asaf Bitton
- Asaf Bitton is an assistant professor of medicine and health care policy at Harvard Medical School and Brigham and Women's Hospital, in Boston. He is also a core faculty member at Harvard Medical School's Center for Primary Care
| | - Johan Hong
- Johan Hong is a research assistant in the Department of Health Care Policy, Harvard Medical School
| | - Bruce E Landon
- Bruce E. Landon is a professor of health care policy and medicine in the Department of Health Care Policy, Harvard Medical School, and in the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, in Boston
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17
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Van Cleave J, Okumura MJ, Swigonski N, O'Connor KG, Mann M, Lail JL. Medical Homes for Children With Special Health Care Needs: Primary Care or Subspecialty Service? Acad Pediatr 2016; 16:366-72. [PMID: 26523634 DOI: 10.1016/j.acap.2015.10.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine primary care pediatricians' (PCPs) beliefs about whether the family-centered medical home (FCMH) should be in primary or subspecialty care for children with different degrees of complexity; and to examine practice characteristics associated with these beliefs. METHODS Data from the American Academy of Pediatrics Periodic Survey (PS 79) conducted in 2012 were analyzed. Outcomes were agreement/strong agreement that 1) primary care should be the FCMH locus for most children with special health care needs (CSHCN) and 2) subspecialty care is the best FCMH locus for children with rare or complex conditions. In multivariate models, we tested associations between outcomes and practice barriers (eg, work culture, time, cost) and facilitators (eg, having a care coordinator) to FCMH implementation. RESULTS Among 572 PCPs, 65% agreed/strongly agreed primary care is the best FCMH setting for most CSHCN, and 43% agreed/strongly agreed subspecialty care is the best setting for children with complexity. Cost and time as barriers to FCMH implementation were oppositely associated with the belief that primary care was best for most CSHCN (cost: adjusted odds ratio [AOR] 2.31, 1.36-3.90; time: AOR 0.48, 0.29-0.81). Lack of skills to communicate and coordinate care was associated with the belief that specialty care was the best FCMH for children with complexity (AOR 1.99, 1.05-3.79). CONCLUSIONS A substantial minority endorsed specialty care as the best FCMH locus for children with medical complexity. Several barriers were associated with believing primary care to be the best FCMH for most CSHCN. Addressing medical complexity in FCMH implementation may enhance perceived value by pediatricians.
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Affiliation(s)
- Jeanne Van Cleave
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Megumi J Okumura
- Department of Pediatrics and Internal Medicine, University of California San Francisco School of Medicine, San Francisco, Calif
| | - Nancy Swigonski
- Children's Health Services Research, University of Indiana, Indianapolis, Ind
| | - Karen G O'Connor
- Department of Research, American Academy of Pediatrics, Elk Grove Village, Ill
| | - Marie Mann
- HRSA/Maternal and Child Health Bureau, US Department of Health and Human Services, Rockville, Md
| | - Jennifer L Lail
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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18
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Njeru JW, DeJesus RS, St Sauver J, Rutten LJ, Jacobson DJ, Wilson P, Wieland ML. Utilization of a mental health collaborative care model among patients who require interpreter services. Int J Ment Health Syst 2016; 10:15. [PMID: 26933447 PMCID: PMC4772682 DOI: 10.1186/s13033-016-0044-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/13/2016] [Indexed: 12/28/2022] Open
Abstract
Background Immigrants and refugees to the United States have a higher prevalence of depression compared to the general population and are less likely to receive adequate mental health services and treatment. Those with limited English proficiency (LEP) are at an even higher risk of inadequate mental health care. Collaborative care management (CCM) models for depression are effective in achieving treatment goals among a wide range of patient populations, including patients with LEP. The purpose of this study was to assess the utilization of a statewide initiative that uses CCM for depression management, among patients with LEP in a large primary care practice. Methods This was a retrospective cohort study of patients with depression in a large primary care practice in Minnesota. Patients who met criteria for enrollment into the CCM [with a provider-generated diagnosis of depression or dysthymia in the electronic medical records, and a Patient Health Questionnaire-9 (PHQ-9) score ≥10]. Patient-identified need for interpreter services was used as a proxy for LEP. Rates of enrollment into the DIAMOND (Depression Improvement Across Minnesota, Offering A New Direction) program, a statewide initiative that uses CCM for depression management were measured. These rates were compared between eligible patients who require interpreter services versus patients who do not. Results Of the 7561 patients who met criteria for enrollment into the DIAMOND program during the study interval, 3511 were enrolled. Only 18.2 % of the eligible patients with LEP were enrolled into DIAMOND compared with the 47.2 % of the eligible English proficient patients. This finding persisted after adjustment for differences in age, gender and depression severity scores (adjusted OR [95 % confidence interval] = 0.43 [0.23, 0.81]). Conclusions Within primary care practices, tailored interventions are needed, including those that address cultural competence and language navigation, to improve the utilization of this effective model among patients with LEP.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ; Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Ramona S DeJesus
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ; Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Jennifer St Sauver
- Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA ; Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | - Lila J Rutten
- Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA ; Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | - Patrick Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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19
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Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use. J Gen Intern Med 2015; 30:1828-36. [PMID: 26037232 PMCID: PMC4636587 DOI: 10.1007/s11606-015-3417-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/15/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. OBJECTIVE To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). DESIGN Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. PARTICIPANTS A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. MAIN MEASURES We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. RESULTS Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI = 1.0-19.0). CONCLUSIONS Access to a usual provider is associated with increased receipt of needed MHS. Patients who have a usual provider with PCMH qualities are more likely to receive mental health counseling.
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20
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Maeng DD, Snyder SR, Baumgart C, Minnich AL, Tomcavage JF, Graf TR. Medicaid Managed Care in an Integrated Health Care Delivery System: Lessons from Geisinger's Early Experience. Popul Health Manag 2015; 19:257-63. [PMID: 26565693 DOI: 10.1089/pop.2015.0079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Many states in the United States, including Pennsylvania, have opted to rely on private managed care organizations to provide health insurance coverage for their Medicaid population in recent years. Geisinger Health System has been one such organization since 2013. Based on its existing care management model involving data-driven population management, advanced patient-centered medical homes, and targeted case management, Geisinger's Medicaid management efforts have been redesigned specifically to accommodate those with complex health care issues and social service needs to facilitate early intervention, effective and efficient care support, and ultimately, a positive impact on health care outcomes. An analysis of Geisinger's claims data suggests that during the first 19 months since beginning Medicaid member enrollment, Geisinger's Medicaid members, particularly those eligible for the supplemental security income benefits, have incurred lower inpatient, outpatient, and professional costs of care compared to expected levels. However, the total cost savings were partially offset by the higher prescription drug costs. These early data suggest that an integrated Medicaid care management effort may achieve significant cost of care savings. (Population Health Management 2016;19:257-263).
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21
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Jones C, Finison K, McGraves-Lloyd K, Tremblay T, Mohlman MK, Tanzman B, Hazard M, Maier S, Samuelson J. Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care. Popul Health Manag 2015; 19:196-205. [PMID: 26348492 PMCID: PMC4913508 DOI: 10.1089/pop.2015.0055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by −$482 relative to the comparison (95% CI, −$573 to −$391; P < .001). The lower costs were driven primarily by inpatient (−$218; P < .001) and outpatient hospital expenditures (−$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196–205)
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Affiliation(s)
- Craig Jones
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | | | | | - Timothy Tremblay
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Mary Kate Mohlman
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Beth Tanzman
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Miki Hazard
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Steven Maier
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Jenney Samuelson
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
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22
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Groenewegen P, Heinemann S, Greß S, Schäfer W. Primary care practice composition in 34 countries. Health Policy 2015; 119:1576-83. [PMID: 26319096 DOI: 10.1016/j.healthpol.2015.08.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/30/2022]
Abstract
Health care needs in the population change through ageing and increasing multimorbidity. Primary health care might accommodate to this through the composition of practices in terms of the professionals working in them. The aim of this article is to describe the composition of primary care practices in 34 countries and to analyse its relationship to practice circumstances and the organization of the primary care system. The data were collected through a survey among samples of general practitioners (n=7183) in 34 countries. In some countries, primary care is mainly provided in single-handed practices. Other countries which have larger practices with multiple professional groups. There is no overall relationship between the professional groups in the practice and practice location. Practices that are located further from other primary care practices have more different professions. Practices with a more than average share of socially disadvantaged people and/or ethnic minorities have more different professions. In countries with a stronger pro-primary care workforce development and more comprehensive primary care delivery the number of different professions is higher. In conclusion, primary care practice composition varies strongly. The organizational scale of primary care is largely country dependent, but this is only partly explained by system characteristics.
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Affiliation(s)
- Peter Groenewegen
- NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands; Utrecht University, Department of Human Geography, Utrecht, The Netherlands; Utrecht University, Department of Sociology, Utrecht, The Netherlands.
| | - Stephanie Heinemann
- Hochschule Fulda - University of Applied Sciences, Department of Health Sciences, Leipziger Straße 123, 36037 Fulda, Germany.
| | - Stefan Greß
- Hochschule Fulda - University of Applied Sciences, Department of Health Sciences, Leipziger Straße 123, 36037 Fulda, Germany.
| | - Willemijn Schäfer
- NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands.
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23
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Kohler RE, Goyal RK, Lich KH, Domino ME, Wheeler SB. Association between medical home enrollment and health care utilization and costs among breast cancer patients in a state Medicaid program. Cancer 2015; 121:3975-81. [PMID: 26287506 DOI: 10.1002/cncr.29596] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The patient-centered medical home (PCMH) is increasingly being implemented in an effort to improve and coordinate primary care, but its effect on health care utilization among breast cancer patients remains unclear. The objective of this study was to examine health care utilization and expenditures as a function of PCMH enrollment among breast cancer patients in North Carolina's Medicaid program. METHODS North Carolina Medicaid claims linked to North Carolina Central Cancer Registry records (2003-2007) were used to examine monthly patterns of health care use and expenditures. Controlling for a selection bias for time-invariant characteristics, fixed effects regression models analyzed associations between PCMH enrollment and utilization of outpatient, inpatient, and emergency department (ED) services and Medicaid expenditures during the 15 months after the diagnosis of breast cancer. RESULTS Among 758 breast cancer patients, 381 (50%) were enrolled in a PCMH at some time in the 15 months after diagnosis. After controlling for individual fixed effects, PCMH enrollment was significantly associated with greater outpatient service use, but there was no difference in the probability of inpatient hospitalizations or ED visits. Enrollment in a PCMH was associated with increased average expenditures of $429 per month during the first 15 months. CONCLUSIONS Greater outpatient care utilization and increased average expenditures among breast cancer patients enrolled in a PCMH may suggest that these women have improved access to primary and specialty care. Expanding PCMHs may change patterns of service utilization for Medicaid breast cancer patients but may not be associated with lower costs.
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Affiliation(s)
- Racquel E Kohler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ravi K Goyal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,RTI Health Solutions, Research Triangle Park, North Carolina
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marisa Elena Domino
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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24
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Cunningham R. Once A Welfare Add-On, Medicaid Takes Charge In Reinventing Care. Health Aff (Millwood) 2015; 34:1080-3. [DOI: 10.1377/hlthaff.2015.0552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rob Cunningham
- Rob Cunningham ( ) is a consulting editor for Health Affairs . He is based in Gaithersburg, Maryland
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25
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Reynolds PP, Klink K, Gilman S, Green LA, Phillips RS, Shipman S, Keahey D, Rugen K, Davis M. The Patient-Centered Medical Home: Preparation of the Workforce, More Questions than Answers. J Gen Intern Med 2015; 30:1013-7. [PMID: 25707941 PMCID: PMC4471027 DOI: 10.1007/s11606-015-3229-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 10/08/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
As American medicine continues to undergo significant transformation, the patient-centered medical home (PCMH) is emerging as an interprofessional primary care model designed to deliver the right care for patients, by the right professional, at the right time, in the right setting, for the right cost. A review of local, state, regional and national initiatives to train professionals in delivering care within the PCMH model reveals some successes, but substantial challenges. Workforce policy recommendations designed to improve PCMH effectiveness and efficiency include 1) adoption of an expanded definition of primary care, 2) fundamental redesign of health professions education, 3) payment reform, 4) responsiveness to local needs assessments, and 5) systems improvement to emphasize quality, population health, and health disparities.
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26
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Van Cleave J, Boudreau AA, McAllister J, Cooley WC, Maxwell A, Kuhlthau K. Care coordination over time in medical homes for children with special health care needs. Pediatrics 2015; 135:1018-26. [PMID: 25963012 PMCID: PMC8194473 DOI: 10.1542/peds.2014-1067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To explore how care coordination changes conceptually and practically in primary care practices when implementing the medical home and to identify reasons for different types of changes. METHODS Six years after a 2003-2004 national learning collaborative to implement the medical home model for children with special health care needs, we examined care coordination in 12 pediatric practices with the highest postintervention Medical Home Index scores, indicating high level of adoption of the model. Data included interviews of 48 clinicians, care coordinators, and parents and medical record reviews of 60 patients with special health care needs receiving care in these practices. RESULTS Initially, care coordination activities were prompted by patients' acute problems, and over time activities, tools, and policies were implemented to avert many such problems and expand the scope of services offered to patients. Example activities were making previsit calls with families, writing care plans, developing relationships with community agencies, and tracking referrals. Although some activities were common across practices, the persons involved and efforts toward different activities varied with practice context. Drivers included motivation and creativity of medical home teams, organizational changes, funding to expand care coordinator positions, protected time for such activities, and adoption of electronic record systems. CONCLUSIONS In high-performing medical homes, care coordination activities changed from being mostly reactive to patients' episodic needs to being more systematically proactive and comprehensive. This shift was promoted by factors external and internal to the practice. Ensuring these factors in medical home implementation may accelerate adoption of proactive care coordination activities.
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Affiliation(s)
- Jeanne Van Cleave
- Division of General Pediatrics/MGH Center for Child and Adolescent Health Research & Policy, MassGeneral Hospital for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
| | - Alexy Arauz Boudreau
- Division of General Pediatrics/MGH Center for Child and Adolescent Health Research & Policy, MassGeneral Hospital for Children, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jeanne McAllister
- Children’s Health Services Research, Indiana University Medical School, Indianapolis, Indiana;,Center for Medical Home Improvement, Crotched Mountain Foundation, Greenfield, New Hampshire; and
| | - W. Carl Cooley
- Center for Medical Home Improvement, Crotched Mountain Foundation, Greenfield, New Hampshire; and
| | - Andrea Maxwell
- Internal Medicine/Pediatrics Residency Program, University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Kuhlthau
- Division of General Pediatrics/MGH Center for Child and Adolescent Health Research & Policy, MassGeneral Hospital for Children, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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27
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Njeru JW, St Sauver JL, Jacobson DJ, Ebbert JO, Takahashi PY, Fan C, Wieland ML. Emergency department and inpatient health care utilization among patients who require interpreter services. BMC Health Serv Res 2015; 15:214. [PMID: 26022227 PMCID: PMC4448538 DOI: 10.1186/s12913-015-0874-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited English proficiency is associated with health disparities and suboptimal health outcomes. Although Limited English proficiency is a barrier to effective health care, its association with inpatient health care utilization is unclear. The aim of this study was to examine the association between patients with limited English proficiency, and emergency department visits and hospital admissions. METHODS We compared emergency department visits and hospitalizations in 2012 between patients requiring interpreter services and age-matched English-proficient patients (who did not require interpreters), in a retrospective cohort study of adult patients actively empanelled to a large primary health care network in a medium-sized United States city (n = 3,784). RESULTS Patients who required interpreter services had significantly more Emergency Department visits (841 vs 620; P ≤ .001) and hospitalizations (408 vs 343; P ≤ .001) than patients who did not require interpreter services. On regression analysis the risk of a first Emergency Department visit was 60% higher for patients requiring interpreter services than those who did not (unadjusted hazard ratio [HR], 1.6; 95% confidence interval (CI), 1.4-1.9; P < .05), while that of a first hospitalization was 50% higher (unadjusted HR, 1.5; 95% CI, 1.2-1.8; P < .05). These findings remained significant after adjusting for age, sex, medical complexity, residency and outpatient health care utilization. CONCLUSIONS Patients who required interpreter services had higher rates of inpatient health care utilization compared with patients who did not require an interpreter. Further research is required to understand factors associated with this utilization and to develop sociolinguistically tailored interventions to facilitate appropriate health care provision for this population.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | | | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
| | - Jon O Ebbert
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Chun Fan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Greenfield EA, Oberlink M, Scharlach AE, Neal MB, Stafford PB. Age-Friendly Community Initiatives: Conceptual Issues and Key Questions. THE GERONTOLOGIST 2015; 55:191-8. [DOI: 10.1093/geront/gnv005] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 01/14/2015] [Indexed: 11/13/2022] Open
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Haley SJ, Kreek MJ. A window of opportunity: maximizing the effectiveness of new HCV regimens in the United States with the expansion of the Affordable Care Act. Am J Public Health 2015; 105:457-63. [PMID: 25602859 PMCID: PMC4330831 DOI: 10.2105/ajph.2014.302327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2014] [Indexed: 12/18/2022]
Abstract
Patients with chronic HCV have predictable overlapping comorbidities that reduce access to care. The Affordable Care Act (ACA) presents an opportunity to focus on the benefits of the medical home model for integrated chronic disease management. New, highly effective HCV treatment regimens in combination with the medical home model could reduce disease prevalence. We sought to address challenges posed by comorbidities in patients with chronic HCV infection and limitations within our health care system, and recommend solutions to maximize the public benefit from ACA and the new drug regimen.
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Affiliation(s)
- Sean J Haley
- Sean J. Haley is with the Department of Health and Nutrition Sciences, Brooklyn College and the City University of New York, School of Public Health, New York. Mary Jeanne Kreek is with the Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York
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Stanhope V, Videka L, Thorning H, McKay M. Moving toward integrated health: an opportunity for social work. SOCIAL WORK IN HEALTH CARE 2015; 54:383-407. [PMID: 25985284 DOI: 10.1080/00981389.2015.1025122] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With the passage of the Patient Protection and Affordable Care Act (PPACA) and ongoing health care reform efforts, this is a critical time for the social work profession. The approaches and values embedded in health care reform are congruent with social work. One strategy is to improve care for people with co-morbid and chronic illnesses by integrating primary care and behavioral health services. This paper defines integrated health and how the PPACA promotes integrated health care through system redesign and payment reform. We consider how social workers can prepare for health care reform and discuss the implications of these changes for the future of the profession.
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Affiliation(s)
- Victoria Stanhope
- a Silver School of Social Work, New York University , New York , New York , USA
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Wang JJ, Cha J, Sebek KM, McCullough CM, Parsons AS, Singer J, Shih SC. Factors related to clinical quality improvement for small practices using an EHR. Health Serv Res 2014; 49:1729-46. [PMID: 25287906 PMCID: PMC4254122 DOI: 10.1111/1475-6773.12243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To analyze the impact of three primary care practice transformation program models on performance: Meaningful Use (MU), Patient-Centered Medical Home (PCMH), and a pay-for-performance program (eHearts). DATA SOURCES/STUDY SETTING Data for seven quality measures (QM) were retrospectively collected from 192 small primary care practices between October 2009 and October 2012; practice demographics and program participation status were extracted from in-house data. STUDY DESIGN Bivariate analyses were conducted to measure the impact of individual programs, and a Generalized Estimating Equation model was built to test the impact of each program alongside the others. DATA COLLECTION/EXTRACTION METHODS Monthly data were extracted via a structured query data network and were compared to program participation status, adjusting for variables including practice size and patient volume. Seven QMs were analyzed related to smoking prevention, blood pressure control, BMI, diabetes, and antithrombotic therapy. PRINCIPAL FINDINGS In bivariate analysis, MU practices tended to perform better on process measures, PCMH practices on more complex process measures, and eHearts practices on measures for which they were incentivized; in multivariate analysis, PCMH recognition was associated with better performance on more QMs than any other program. CONCLUSIONS Results suggest each of the programs can positively impact performance. In our data, PCMH appears to have the most positive impact.
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Affiliation(s)
- Jason J Wang
- Primary Care Information Project (PCIP), NYC DOHMHLong Island City (Queens), NY 11101
| | - Jisung Cha
- Primary Care Information Project (PCIP), NYC DOHMHLong Island City (Queens), NY
| | - Kimberly M Sebek
- Primary Care Information Project (PCIP), NYC DOHMHLong Island City (Queens), NY
| | | | - Amanda S Parsons
- Department of Population and Community Health, Montefiore Medical CenterBronx, NY
| | - Jesse Singer
- Primary Care Information Project (PCIP), NYC DOHMHLong Island City (Queens), NY
| | - Sarah C Shih
- Primary Care Information Project (PCIP), NYC DOHMHLong Island City (Queens), NY
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Edwards ST, Abrams MK, Baron RJ, Berenson RA, Rich EC, Rosenthal GE, Rosenthal MB, Landon BE. Structuring payment to medical homes after the affordable care act. J Gen Intern Med 2014; 29:1410-3. [PMID: 24687292 PMCID: PMC4175661 DOI: 10.1007/s11606-014-2848-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 02/20/2014] [Accepted: 03/12/2014] [Indexed: 12/23/2022]
Abstract
The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.
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Affiliation(s)
- Samuel T Edwards
- Section of General Internal Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, USA
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Saitz R, Palfai TPA, Cheng DM, Alford DP, Bernstein JA, Lloyd-Travaglini CA, Meli SM, Chaisson CE, Samet JH. Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial. JAMA 2014; 312:502-13. [PMID: 25096690 PMCID: PMC4667772 DOI: 10.1001/jama.2014.7862] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The United States has invested substantially in screening and brief intervention for illicit drug use and prescription drug misuse, based in part on evidence of efficacy for unhealthy alcohol use. However, it is not a recommended universal preventive service in primary care because of lack of evidence of efficacy. OBJECTIVE To test the efficacy of 2 brief counseling interventions for unhealthy drug use (any illicit drug use or prescription drug misuse)-a brief negotiated interview (BNI) and an adaptation of motivational interviewing (MOTIV)-compared with no brief intervention. DESIGN, SETTING, AND PARTICIPANTS This 3-group randomized trial took place at an urban hospital-based primary care internal medicine practice; 528 adult primary care patients with drug use (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST] substance-specific scores of ≥4) were identified by screening between June 2009 and January 2012 in Boston, Massachusetts. INTERVENTIONS Two interventions were tested: the BNI is a 10- to 15-minute structured interview conducted by health educators; the MOTIV is a 30- to 45-minute intervention based on motivational interviewing with a 20- to 30-minute booster conducted by master's-level counselors. All study participants received a written list of substance use disorder treatment and mutual help resources. MAIN OUTCOMES AND MEASURES Primary outcome was number of days of use in the past 30 days of the self-identified main drug as determined by a validated calendar method at 6 months. Secondary outcomes included other self-reported measures of drug use, drug use according to hair testing, ASSIST scores (severity), drug use consequences, unsafe sex, mutual help meeting attendance, and health care utilization. RESULTS At baseline, 63% of participants reported their main drug was marijuana, 19% cocaine, and 17% opioids. At 6 months, 98% completed follow-up. Mean adjusted number of days using the main drug at 6 months was 12 for no brief intervention vs 11 for the BNI group (incidence rate ratio [IRR], 0.97; 95% CI, 0.77-1.22) and 12 for the MOTIV group (IRR, 1.05; 95% CI, 0.84-1.32; P = .81 for both comparisons vs no brief intervention). There were also no significant effects of BNI or MOTIV on any other outcome or in analyses stratified by main drug or drug use severity. CONCLUSIONS AND RELEVANCE Brief intervention did not have efficacy for decreasing unhealthy drug use in primary care patients identified by screening. These results do not support widespread implementation of illicit drug use and prescription drug misuse screening and brief intervention. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00876941.
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Affiliation(s)
- Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts2Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston
| | - Tibor P A Palfai
- Department of Psychology, Boston University, Boston, Massachusetts
| | - Debbie M Cheng
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts4Department of Biostatistics, Boston University Schoo
| | - Daniel P Alford
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Judith A Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | | | - Seville M Meli
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Christine E Chaisson
- Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts
| | - Jeffrey H Samet
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts2Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston
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Pappas G, Yujiang J, Seiler N, Malcarney MB, Horton K, Shaikh I, Freehill G, Alexander C, Akhter MN, Hidalgo J. Perspectives on the role of patient-centered medical homes in HIV Care. Am J Public Health 2014; 104:e49-53. [PMID: 24832431 PMCID: PMC4056203 DOI: 10.2105/ajph.2014.302022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2014] [Indexed: 01/22/2023]
Abstract
To strengthen the quality of HIV care and achieve improved clinical outcomes, payers, providers, and policymakers should encourage the use of patient-centered medical homes (PCMHs), building on the Ryan White CARE Act Program established in the 1990s. The rationale for a PCMH with HIV-specific expertise is rooted in clinical complexity, HIV's social context, and ongoing gaps in HIV care. Existing Ryan White HIV/AIDS Program clinicians are prime candidates to serve HIV PCMHs, and HIV-experienced community-based organizations can play an important role. Increasingly, state Medicaid programs are adopting a PCMH care model to improve access and quality to care. Stakeholders should consider several important areas for future action and research with regard to development of the HIV PCMH.
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Affiliation(s)
- Gregory Pappas
- At the time of initial writing and research, Gregory Pappas, Jia Yujiang, Irshad Shaikh, Gunther Freehill, and Mohammad N. Akhter were with the District of Columbia Department of Health, Washington, DC. Naomi Seiler, Mary-Beth Malcarney, Katherine Horton, and Julia Hidalgo were with the Milken Institute School of Public Health, George Washington University, Washington, DC. Carla Alexander was with Institute of Human Virology, University of Maryland School of Medicine, Baltimore
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Solberg LI, Stuck LH, Crain AL, Tillema JO, Flottemesch TJ, Whitebird RR, Fontaine PL. Organizational factors and change strategies associated with medical home transformation. Am J Med Qual 2014; 30:337-44. [PMID: 24788251 DOI: 10.1177/1062860614532307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is limited information about how to transform primary care practices into medical homes. The research team surveyed leaders of the first 132 primary care practices in Minnesota to achieve medical home certification. These surveys measured priority for transformation, the presence of medical home practice systems, and the presence of various organizational factors and change strategies. Survey response rates were 98% for the Change Process Capability Questionnaire survey and 92% for the Physician Practice Connections survey. They showed that 80% to 100% of these certified clinics had 15 of the 18 organizational factors important for improving care processes and that 60% to 90% had successfully used 16 improvement strategies. Higher priority for this change (P = .001) and use of more strategies (P = .05) were predictive of greater change in systems. Clinics contemplating medical home transformation should consider the factors and strategies identified here and should be sure that such a change is indeed a high priority for them.
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Affiliation(s)
- Leif I Solberg
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Logan H Stuck
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - A Lauren Crain
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Juliana O Tillema
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | | | - Robin R Whitebird
- HealthPartners Institute for Education and Research, Minneapolis, MN
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Davis M, Abrams MT, Wissow LS, Slade EP. Identifying young adults at risk of Medicaid enrollment lapses after inpatient mental health treatment. Psychiatr Serv 2014; 65:461-8. [PMID: 24382689 PMCID: PMC3972275 DOI: 10.1176/appi.ps.201300199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study sought to describe Medicaid disenrollment rates and risk factors among young adults after discharge from inpatient psychiatric treatment. METHODS The sample included 1,176 Medicaid-enrolled young adults ages 18 to 26 discharged from inpatient psychiatric care in a mid-Atlantic state. Medicaid disenrollment in the 365 days postdischarge and disenrollment predictors from the 180-day predischarge period (antecedent period) were identified from administrative records. Classification and regression tree and probit regression analysis were used. RESULTS Thirty-two percent were disenrolled from Medicaid within a year of discharge. Both analytical approaches converged on four main risk factors: being in the Medicaid enrollment category for persons with a nondisabled low-income parent or for a child in a low-income household, being age 18 or 20 at discharge, having a Medicaid enrollment gap in the antecedent period, and having no primary care utilization in the antecedent period. For the 48% of the sample continuously enrolled in the antecedent period who were in the enrollment categories for disabled adults or foster care children, the disenrollment rate was 13%. CONCLUSIONS A substantial minority of Medicaid-enrolled young adults discharged from inpatient care were disenrolled from Medicaid within a year. About half the sample had a low disenrollment risk, but the other half was at substantial risk. Risk factors largely reflected legal status changes that occur among these transition-age youths. Identifying inpatients at high risk of disenrollment and ensuring continuous coverage should improve access to needed postdischarge supports. Regular primary care visits may also help reduce unintended Medicaid disenrollment in this population.
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Hearld LR, Hearld KR, Hogan TH. Community-level sociodemographic characteristics and patient-centered medical home capacity. Adv Health Care Manag 2014; 16:23-50. [PMID: 25626198 DOI: 10.1108/s1474-823120140000016002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Longitudinally (2008-2012) assess whether community-level sociodemographic characteristics were associated with patient-centered medical home (PCMH) capacity among primary care and specialty physician practices, and the extent to which variation in PCMH capacity can be accounted for by sociodemographic characteristics of the community. DESIGN/METHODOLOGY/APPROACH Linear growth curve models among 523 small and medium-sized physician practices that were members of a consortium of physician organizations pursuing the PCMH. FINDINGS Our analysis indicated that the average level of sociodemographic characteristics was typically not associated with the level of PCMH capacity, but the heterogeneity of the surrounding community is generally associated with lower levels of capacity. Furthermore, these relationships differed for interpersonal and technical dimensions of the PCMH. IMPLICATIONS Our findings suggest that PCMH capabilities may not be evenly distributed across communities and raise questions about whether such distributional differences influence the PCMH's ability to improve population health, especially the health of vulnerable populations. Such nuances highlight the challenges faced by practitioners and policy makers who advocate the continued expansion of the PCMH as a means of improving the health of local communities. ORIGINALITY/VALUE To date, most studies have focused cross-sectionally on practice characteristics and their association with PCMH adoption. Less understood is how physician practices' PCMH adoption varies as a function of the sociodemographic characteristics of the community in which the practice is located, despite work that acknowledges the importance of social context in decisions about adoption and implementation that can affect the dissemination of innovations.
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Fillmore H, DuBard CA, Ritter GA, Jackson CT. Health care savings with the patient-centered medical home: Community Care of North Carolina's experience. Popul Health Manag 2013; 17:141-8. [PMID: 24053757 DOI: 10.1089/pop.2013.0055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study evaluated the financial impact of integrating a systemic care management intervention program (Community Care of North Carolina) with person-centered medical homes throughout North Carolina for non-elderly Medicaid recipients with disabilities during almost 5 years of program history. It examined Medicaid claims for 169,676 non-elderly Medicaid recipients with disabilities from January 2007 through third quarter 2011. Two models were used to estimate the program's impact on cost, within each year. The first employed a mixed model comparing member experiences in enrolled versus unenrolled months, accounting for regional differences as fixed effects and within physician group experience as random effects. The second was a pre-post, intervention/comparison group, difference-in-differences mixed model, which directly matched cohort samples of enrolled and unenrolled members on strata of preenrollment pharmacy use, race, age, year, months in pre-post periods, health status, and behavioral health history. The study team found significant cost avoidance associated with program enrollment for the non-elderly disabled population after the first years, savings that increased with length of time in the program. The impact of the program was greater in persons with multiple chronic disease conditions. By providing targeted care management interventions, aligned with person-centered medical homes, the Community Care of North Carolina program achieved significant savings for a high-risk population in the North Carolina Medicaid program.
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Camp KM, Lloyd-Puryear MA, Yao L, Groft SC, Parisi MA, Mulberg A, Gopal-Srivastava R, Cederbaum S, Enns GM, Ershow AG, Frazier DM, Gohagan J, Harding C, Howell RR, Regan K, Stacpoole PW, Venditti C, Vockley J, Watson M, Coates PM. Expanding research to provide an evidence base for nutritional interventions for the management of inborn errors of metabolism. Mol Genet Metab 2013; 109:319-28. [PMID: 23806236 PMCID: PMC4131198 DOI: 10.1016/j.ymgme.2013.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 11/27/2022]
Abstract
A trans-National Institutes of Health initiative, Nutrition and Dietary Supplement Interventions for Inborn Errors of Metabolism (NDSI-IEM), was launched in 2010 to identify gaps in knowledge regarding the safety and utility of nutritional interventions for the management of inborn errors of metabolism (IEM) that need to be filled with evidence-based research. IEM include inherited biochemical disorders in which specific enzyme defects interfere with the normal metabolism of exogenous (dietary) or endogenous protein, carbohydrate, or fat. For some of these IEM, effective management depends primarily on nutritional interventions. Further research is needed to demonstrate the impact of nutritional interventions on individual health outcomes and on the psychosocial issues identified by patients and their families. A series of meetings and discussions were convened to explore the current United States' funding and regulatory infrastructure and the challenges to the conduct of research for nutritional interventions for the management of IEM. Although the research and regulatory infrastructure are well-established, a collaborative pathway that includes the professional and advocacy rare disease community and federal regulatory and research agencies will be needed to overcome current barriers.
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Affiliation(s)
- Kathryn M. Camp
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Lynne Yao
- U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Stephen C. Groft
- Office of Rare Diseases Research, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD 20892, USA
| | - Melissa A. Parisi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Andrew Mulberg
- U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Rashmi Gopal-Srivastava
- Office of Rare Diseases Research, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Gregory M. Enns
- Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Abby G. Ershow
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Dianne M. Frazier
- University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA
| | - John Gohagan
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD 20892, USA
| | - Cary Harding
- Oregon Health and Science University, Portland, OR 97239, USA
| | | | - Karen Regan
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA
- Division of Nutrition Research Coordination, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Charles Venditti
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jerry Vockley
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Michael Watson
- American College of Medical Genetics and Genomics, Bethesda, MD 20814, USA
| | - Paul M. Coates
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA
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Abstract
The Affordable Care Act is transforming American federalism and creating strain between the states and the federal government. By expanding the scale of intergovernmental health programs, creating new state requirements, and setting the stage for increased federal fiscal oversight, the act has disturbed an uneasy truce in American federalism. This article outlines a policy proposal designed to harness cooperative federalism, based on the shared state and federal desire to control health care cost growth. The proposal, which borrows features of the Medicare Shared Savings Program, would provide states with an incentive in the form of an increased share of the savings they generate in programs that have federal financial participation, as long as they meet defined performance standards.
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Affiliation(s)
- Alan Weil
- National Academy for State Health Policy, Washington, DC, USA.
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