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    Bending the cost curve? Results from a comprehensive primary care payment pilot

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    Authors
    Vats, Sonal
    Ash, Arlene S.
    Ellis, Randall P.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2013-11-01
    Keywords
    Adult
    Aged
    Algorithms
    Female
    Health Expenditures
    Humans
    Insurance Claim Review
    Insurance Coverage
    Insurance, Health
    Male
    Massachusetts
    Medicaid
    Medicare
    Middle Aged
    Patient-Centered Care
    Primary Health Care
    Propensity Score
    Risk Adjustment
    United States
    UMCCTS funding
    Health Services Administration
    Primary Care
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    Link to Full Text
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845668/
    Abstract
    BACKGROUND: There is much interest in understanding how using bundled primary care payments to support a patient-centered medical home (PCMH) affects total medical costs. RESEARCH DESIGN AND SUBJECTS: We compare 2008-2010 claims and eligibility records on about 10,000 patients in practices transforming to a PCMH and receiving risk-adjusted base payments and bonuses, with similar data on approximately 200,000 patients of nontransformed practices remaining under fee-for-service reimbursement. METHODS: We estimate the treatment effect using difference-in-differences, controlling for trend, payer type, plan type, and fixed effects. We weight to account for partial-year eligibility, use propensity weights to address differences in exogenous variables between control and treatment patients, and use the Massachusetts Health Quality Project algorithm to assign patients to practices. RESULTS: Estimated treatment effects are sensitive to: control variables, propensity weighting, the algorithm used to assign patients to practices, how we address differences in health risk, and whether/how we use data from enrollees who join, leave, or change practices. Unadjusted PCMH spending reductions are 1.5% in year 1 and 1.8% in year 2. With fixed patient assignment and other adjustments, medical spending in the treatment group seems to be 5.8% (P=0.20) lower in year 1 and 8.7% (P=0.14) lower in year 2 than for propensity-weighted, continuously enrolled controls; the largest proportional 2-year reduction in spending occurs in laboratory test use (16.5%, P=0.02). CONCLUSIONS: Although estimates are imprecise because of limited data and quasi-experimental design, risk-adjusted bundled payment for primary care may have dampened spending growth in 3 practices implementing a PCMH.
    Source

    Vats S, Ash AS, Ellis RP. Bending the cost curve? Results from a comprehensive primary care payment pilot. Med Care. 2013 Nov;51(11):964-9. doi:10.1097/MLR.0b013e3182a97bdc. Link to article on publisher's site

    DOI
    10.1097/MLR.0b013e3182a97bdc
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/30056
    PubMed ID
    24113816
    Related Resources

    Link to article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1097/MLR.0b013e3182a97bdc
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