The Hilltop Institute at the University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250. Email:
Am J Manag Care. 2023 Dec;29(12):680-686. doi: 10.37765/ajmc.2023.89467.
To evaluate the effect of a statewide multipayer patient-centered medical home (PCMH) demonstration on patients consistently within the highest ranks of health services expenditure across Maryland.
Post hoc longitudinal analyses of administrative data on privately insured patients of medical homes that participated in the Maryland Multi-Payer PCMH Program (MMPP), matched for comparison to medical homes in a single-payer PCMH program and to non-PCMH practices.
Consistently high-cost patients (CHPs) were defined as being in the top statewide quintile of payer expenditure over a 2-year baseline period. Using population-averaged generalized linear regression models, we evaluated the odds of CHPs remaining in the highest-cost quintile during the 2-year MMPP implementation period and assessed changes in their utilization patterns.
Six percent of included patients were CHPs and accounted for one-third of total expenditure. For CHPs in multipayer PCMHs, estimated odds of remaining in this status after 2 years were lower by 34% (adjusted OR [AOR], 0.66; 95% CI, 0.41-0.90; P = .03) relative to CHPs in non-PCMH practices and higher by 41% (AOR, 1.41; 95% CI, 1.08-1.75; P = .004) compared with CHPs in single-payer PCMHs. Relative to CHPs in non-PCMH practices, CHPs in multipayer PCMHs had inpatient admissions decline by 40% (incidence rate ratio [IRR], 0.60; 95% CI, 0.36-1.00; P = .049) and visits to the attributed primary care provider increase by 21% (IRR, 1.21; 95% CI, 1.05-1.39; P = .01).
Relative to routine primary care, the PCMH model significantly reduces the probability that CHPs remain in this expensive category and enhances continuity of care.
评估马里兰州一项多付款人以患者为中心的医疗之家（PCMH）示范项目对医疗支出最高的患者的效果。
对参与马里兰州多付款人 PCMH 计划（MMPP）的医疗之家的私人保险患者的行政数据进行事后纵向分析，与单一付款人 PCMH 计划中的医疗之家和非 PCMH 实践进行匹配比较。
高成本患者（CHP）定义为在两年基线期内处于全州最高支出五分位的患者。使用人群平均广义线性回归模型，我们评估了 CHP 在 MMPP 实施期间两年内仍处于最高成本五分位的可能性，并评估了他们的利用模式变化。
纳入的患者中有 6%是 CHP，占总支出的三分之一。对于多付款人 PCMH 中的 CHP，在两年后仍处于这种状态的估计几率降低了 34%（调整后的 OR [AOR]，0.66；95% CI，0.41-0.90；P=0.03），与非 PCMH 实践中的 CHP 相比，与单一付款人 PCMH 中的 CHP 相比，该比率增加了 41%（AOR，1.41；95% CI，1.08-1.75；P=0.004）。与非 PCMH 实践中的 CHP 相比，多付款人 PCMH 中的 CHP 的住院入院率下降了 40%（发病率比 [IRR]，0.60；95% CI，0.36-1.00；P=0.049），就诊归因初级保健提供者的就诊率增加了 21%（IRR，1.21；95% CI，1.05-1.39；P=0.01）。
与常规初级保健相比，PCMH 模式显著降低了 CHP 仍处于这一昂贵类别的可能性，并增强了护理的连续性。
