Multi-payer PCMH Evaluations: Findings and Methodological Considerations
As of December 2015, eighteen states have multi-payer patient centered medical home (PCMH) initiatives underway, while others are actively planning such initiatives. Meanwhile, many evaluations have been underway in recent years to assess how PCMH initiatives affect cost, utilization, and quality of care. These evaluations often use similar methodologies, but do not always appropriately account for the multi-payer nature of the data or use the most appropriate cost measures, while patient attribution methods vary. Results have been mixed, though programs have generally been associated with modest improvement in quality, some reduced unnecessary utilization, and unclear effects on cost. However, no study to date has conducted a meta-analysis of the PCMH evaluations. In this session, Brown University will first discuss results from a current evaluation of Rhode Island’s statewide multi-payer PCMH initiative—the Care Transformation Collaborative (CTC), which launched in 2008 and has since expanded to 48 practices. This study conducts a propensity-matched difference-in-difference analysis to estimate the effect of the program on costs and utilization for CTC patients, compared to similar, non-CTC patients. Following, Harvard University will present a meta-analysis of PCMH initiatives. This will synthesize the evidence base across numerous states in respect to cost, quality, and utilization outcomes. Finally, RTI will discuss methodological considerations specifically pertaining to multi-payer PCMH evaluations. This will include a discussion of risk-adjustment, price-adjustment, and patient assignment to practices when conducting analyses with multiple payers. It will also discuss the appropriateness of total cost of care measures when conducting PCMH evaluations.