Geisinger Center for Health Research, Danville, PA 17822, USA.
Am J Manag Care. 2012 Mar;18(3):149-55.
To estimate cost savings associated with ProvenHealth Navigator (PHN), which is an advanced model of patient-centered medical homes (PCMHs) developed by Geisinger Health System, and determine whether those savings increase over time.
A retrospective claims data analysis of 43 primary care clinics that were converted into PHN sites between 2006 and 2010. The study population included Geisinger Health Plan's Medicare Advantage plan enrollees who were 65 years or older treated in these clinics (26,303 unique members).
Two patient-level multivariate regression models (with and without interaction effects between prescription drug coverage and PHN exposure) with member fixed effects were used to estimate the effect of members' exposure to PHN on per-member per-month total cost, controlling for member risk, seasonality, yearly trend, and a set of baseline clinic characteristics.
In both models, a longer period of PHN exposure was significantly associated with a lower total cost. The total cumulative cost savings over the study period was 7.1% (95% confi dence interval [CI] 2.6-11.6) using the model with the prescription drug coverage interaction effects and 4.3% (95% CI 0.4-8.3) using the model without the interaction effects. Corresponding return on investment was 1.7 (95% CI 0.3-3.0) and 1.0 (95% Cl -0.1 to 2.0), respectively.
Our finding suggests that PCMHs can lead to significant and sustainable cost savings over time.
估算与 ProvenHealth Navigator（PHN）相关的成本节约，PHN 是由 Geisinger 健康系统开发的一种以患者为中心的医疗之家（PCMH）的先进模式，并确定这些节约是否随着时间的推移而增加。
对 2006 年至 2010 年间转换为 PHN 地点的 43 个初级保健诊所的回顾性索赔数据分析。研究人群包括 Geisinger 健康计划的 Medicare Advantage 计划的 65 岁及以上的参保人，他们在这些诊所接受治疗（26303 名独特的成员）。
使用具有成员固定效应的两个患者水平多元回归模型（具有和不具有处方药覆盖范围与 PHN 暴露之间的交互效应），来估计成员接触 PHN 对每个成员每月总费用的影响，控制成员风险、季节性、年度趋势和一组基线诊所特征。
在两个模型中，较长时间的 PHN 暴露与较低的总费用显著相关。使用具有处方药覆盖范围交互效应的模型，研究期间的总累计成本节约为 7.1%（95%置信区间[CI]2.6-11.6），而使用没有交互效应的模型则为 4.3%（95%CI0.4-8.3）。相应的投资回报率分别为 1.7（95%CI0.3-3.0）和 1.0（95%CI-0.1-2.0）。
我们的发现表明，随着时间的推移，PCMH 可以带来显著和可持续的成本节约。
