Impact of Patient-Centered Medical Home Assignment on Emergency Room Visits Among Uninsured Patients in a County Health System

Roby, Dylan H.; Pourat, Nadereh; Pirritano, Matthew; Vrungos, Shelley; Dajee, Himmet; Castillo, Dan; Kominski, Gerald F.

doi:10.1177/1077558710368682

Cited by 56 publications

(44 citation statements)

References 10 publications

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“…We controlled for covariates previously identified as important predictors of healthcare access and health service use based on the Gelberg-Andersen Behavioral Model for Vulnerable Populations. 42,43 Predisposing characteristics included age, race, gender, U.S. versus foreign-born nativity, marital status, and general healthcare attitudes. Enabling resources included type of insurance, household income, years of education, language spoken at home, and geographic residence.…”

Section: Methodsmentioning

confidence: 99%

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

et al. 2015

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Section: Methodsmentioning

confidence: 99%

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

et al. 2015

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“…47 Our study fills an important gap in the literature because existing demonstration-project evaluation efforts have focused on system-level cost savings (eg, through fewer emergency department or specialty visits), which have been inconsistently observed. 10,[14][15][16]18,[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] For many practices, revenue gains must be observed at the practice level to justify practice-level workforce and time use changes. Another key advantage is that our modeling allows us to compare different reforms in the same practices, unlike demonstration projects for which it is unclear whether differences in outcomes are due to differences in the PCMH funding program itself or preexisting practice differences.…”

Section: Discussionmentioning

confidence: 99%

Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model

Basu

Phillips

Song

et al. 2016

The Annals of Family Medicine

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PURPOSEWe assess the financial implications for primary care practices of participating in patient-centered medical home (PCMH) funding initiatives. METHODSWe estimated practices' changes in net revenue under 3 PCMH funding initiatives: increased fee-for-service (FFS) payments, traditional FFS with additional per-member-per-month (PMPM) payments, or traditional FFS with PMPM and pay-for-performance (P4P) payments. Net revenue estimates were based on a validated microsimulation model utilizing national practice surveys. Simulated practices reflecting the national range of practice size, location, and patient population were examined under several potential changes in clinical services: investments in patient tracking, communications, and quality improvement; increased support staff; altered visit templates to accommodate longer visits, telephone visits or electronic visits; and extended service delivery hours. RESULTSUnder the status quo of traditional FFS payments, clinics operate near their maximum estimated possible net revenue levels, suggesting they respond strongly to existing financial incentives. Practices gained substantial additional net annual revenue per full-time physician under PMPM or PMPM plus P4P payments ($113,300 per year, 95% CI, $28,500 to $198,200) but not under increased FFS payments (-$53,500, 95% CI, -$69,700 to -$37,200), after accounting for costs of meeting PCMH funding requirements. Expanding services beyond minimum required levels decreased net revenue, because traditional FFS revenues decreased.CONCLUSIONS PCMH funding through PMPM payments could substantially improve practice finances but will not offer sufficient financial incentives to expand services beyond minimum requirements for PCMH funding. Ann Fam Med 2016;14:404-414. doi: 10.1370/afm.1960 INTRODUCTIONA s of 2014 at least 114 distinct initiatives from state, federal, and private payers funded primary care clinics to offer services as patient-centered medical homes (PCMHs)-practices delivering comprehensive care for most health problems; coordinating care among multiple clinicians; and achieving heightened standards for accessibility, quality, and safety. [1][2][3][4] These initiatives, which now involve at least 21 million patients in the United States, 4 intend to improve access and quality while delivering population-based care at lower cost. [1][2][3] To do so amidst workforce constraints, practices face challenges, including adopting process improvement techniques and electronic registries for care management, expanding care teams, offering patients longer in-person visits and access to electronic or telephone visits, and extending night and/or weekend business hours to enhance care access. 1,[5][6][7][8] According to recent national surveys, 3 major payment strategies have dominated PCMH initiatives: increased fee-for-service (FFS) payments, traditional FFS payments with additional per-member-per-month (PMPM) payments, and Sanjay Basu, MD, PhD 1,2 Russell S. Phillips, MD 2,3 Zirui Song, MD, PhD 2,4 Bru...

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“…24,25 Patient-centered medical homes are beginning to be implemented, and initial results are promising. 26,27 The National Demonstration Project examined 36 family medicine practices across the country and found that integration of patientcentered medical home components into practice resulted in improved access to care and patient receipt of preventive services 2 years after implementation. 27 For patients who do not seek routine health care, outreach strategies in nontraditional health settings or at opportunistic times such as during emergency room visits 28 may improve access to preventive therapies.…”

Section: Improve Access To Evidence-based Preventive Therapiesmentioning

confidence: 99%

Can We Improve Adherence to Preventive Therapies for Cardiovascular Health?

2011

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A lthough mortality rates from cardiovascular disease (CVD) declined by 26% from 1995 to 2005, 1 it remains the leading cause of death for US adults. The American Heart Association (AHA) set a 2020 impact goal to "improve the cardiovascular health of all Americans by 20% while reducing deaths from CVD and stroke by 20%." 2 To this end, the AHA recommended prevention as a first-line strategy and identified "life's simple seven," 3 lifestyle behaviors and risk factors described in Table 1, which, if appropriately followed or adhered to, will improve cardiovascular health. 2 Adherence refers to the extent to which patient behaviors align with clinical recommendations. 4 The prevention behaviors offered by the AHA can be categorized as follows: (1) lifestyle behaviors, (2) screening, and (3) medication use. Lifestyle behaviors include a healthy diet, maintaining a healthy weight, engaging in physical activity, and not smoking. Screenings include those for blood pressure, lipid levels, and diabetes mellitus. Medication use refers to over-thecounter medications such as aspirin and prescription medications such as lipid-lowering agents and antihypertensive medications.Adherence to preventive therapies is suboptimal. For example, only 5% of adults engage in the recommended amount of physical activity. 5 In comparison, about 43% of adults with a history of CVD or equivalent CVD risk take statins 6 and 57% of adults 25 years old had their cholesterol tested at least once in the past 5 years. 7 High-risk lifestyle behaviors are most prevalent in populations with limited income and education, ethnic/racial minority populations, and in low-income communities. 8,9 The challenge is even more complicated because having multiple risk factors is common. 10 A 2001 National Health Interview Survey reported a clustering of smoking, obesity, physical inactivity, and excessive alcohol intake (41% of US adults had 2 and 17% had 3). 8 Increased adherence to preventive therapies would greatly improve cardiovascular health, leading to reduced health disparities and healthcare costs. 11 Adherence to Preventive Therapies for Cardiovascular Health Is a Complex Process Influenced by Multiple FactorsTo improve adherence to preventive therapies, we must first understand the multiple levels that influence adherence. Within the healthcare system, adherence to preventive therapies is affected by patients, clinicians, and systems. 12 The Expanded Chronic Care Model (ECCM), an adaptation of the original CCM, provides a helpful framework for understanding how to integrate healthcare system-based approaches with communitybased health promotion efforts. 13 The CCM contains 4 components: (1) self-management, (2) delivery system design, (3) decision support, and (4) information systems. The ECCM added 3 components relevant to the community: (1) building public health policy, (2) creating supportive environments, and (3) strengthening community action (Figure 1). We review each of the components of the ECCM and provide examples of how they can be implemen...

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Impact of Patient-Centered Medical Home Assignment on Emergency Room Visits Among Uninsured Patients in a County Health System

Cited by 56 publications

References 10 publications

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model

Can We Improve Adherence to Preventive Therapies for Cardiovascular Health?

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