Early results show wellpoint's patient-centered medical home pilots have met some goals for costs, utilization, and quality

Health Affairs

Volumn 31, Issue 9, 2012, Pages 2002-2009

  Raskas, Ruth S ^a   Latts, Lisa M ^b   Hummel, Jill R ^c   Wenners, Douglas ^c   Levine, Harlan ^d   Nussbaum, Sam R ^c  

^a WellPoint   (United States)

^b LML Health Solutions   (United States)

^c WellPoint's Comprehensive Health Solutions ^*

^d WellPoint's Comprehensive Health Solutions   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE COST; HEALTH CARE QUALITY; HEALTH CARE UTILIZATION; HUMAN; MEDICAL DECISION MAKING; PATIENT CARE; PILOT STUDY; PRIMARY MEDICAL CARE; UNITED STATES;

COLORADO; COST CONTROL; EFFICIENCY, ORGANIZATIONAL; NEW HAMPSHIRE; ORGANIZATIONAL CASE STUDIES; ORGANIZATIONAL OBJECTIVES; PATIENT-CENTERED CARE; PILOT PROJECTS; PRIMARY HEALTH CARE; QUALITY OF HEALTH CARE; REIMBURSEMENT, INCENTIVE;

EID: 84871865311     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2012.0364     Document Type: Article

References (20)

1. Phillips RL Jr, Bazemore AW. Primary care and why it matters for U.S. health system reform. Health Aff (Millwood). 2010;29:806-10.
2. Institute of Medicine Board on Health Care Services. The new definition and an explanation of terms. Part 3 in: Donaldson M, Yordy K, Vanselow N, editors. Defining primary care: an interim report [Internet]. Washington (DC): National Academies Press; 1994 [cited 2012 Aug 13]. Available from: http://www.nap.edu/openbook.php? record_id=9153&page=15
3. Cullen E, Ranji U, Salganicoff A. Primary care shortage [Internet]. Menlo Park (CA): Kaiser Family Foundation; [updated 2011 Apr; cited 2012 Mar 29]. (Background Brief). Available from: http://www.kaiseredu.org/Issue-Modules/ Primary-Care-Shortage/Background-Brief.aspx
4. Patient-Centered Primary Care Collaborative. History of the collaborative [Internet]. Washington (DC): The Collaborative [cited 2012 Mar 29]. Available from: http://www.pcpcc.net/content/historycollaborative
5. The Patient-Centered Primary Care Collaborative educates policy makers about the value of patient-centered medical homes and shares outcomes from these homes. Patient-Centered Primary Care Collaborative. Who we are [Internet]. Washington (DC): The Collaborative [cited 2012 Jun 22]. Available from: http://www.pcpcc.net/who-we-are
6. The collaborative now includes more than 700 employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, and physicians. Patient-Centered Primary Care Collaborative. Health care reform and the patient-centered medical home [Internet]. Washington (DC): The Collaborative [cited 2012 Mar 29]. Available from: http://www.pcpcc.net/content/health-care-reformand-patient-centered-medical-home
7. Harbrecht MG, Latts LM. Colorado's patient-centered medical home pilot met numerous obstacles, yet saw results such as reduced hospital admissions. Health Aff (Millwood). 2012;31(9):2010-17.
8. The participating health plans were Aetna, Anthem-WellPoint, CIGNA, Colorado Medicaid, Cover Colorado, Humana, and UnitedHealthcare
9. The participating employer groups were the Colorado Business Group on Health, IBM, McKesson, and the Patient-Centered Primary Care Collaborative
10. The participating physician medical societies were the American Academy of Family Physicians, American College of Physicians, Colorado Academy of Family Physicians, and Colorado Medical Society
11. The participating independent practice associations were the Integrated Physician Network, Northern Colorado IPA, and Physician Health Partners (Primary Physician Partners and South Metro Physicians)
12. This was the WellPoint health plan rate. Other payers' rates ranged from $4 to $8 per member per month.
13. To access the Appendix, click on the Appendix link in the box to the right of the article online
14. Primary Care Information Project. About the Primary Care Information Project [Internet]. New York (NY): New York City Department of Health and Mental Hygiene; [cited 2012 Mar 29]. Available from: http://www.nyc.gov/html/doh/html/pcip/pcip-summary.shtml
15. DeVries A, Li W, Sridhar G, Hummel J, Breidbart S, Barron J. Comparing quality, healthcare utilization and costs for patient-centered medical home (PCMH) and non-PCMH patients in the pre-recognition period. Am J Manag Care. Forthcoming.
16. The differences in health care utilization were determined with chisquare tests. Two sample t tests and regression models were used to test differences in use of adjusted emergency departments and inpatient services and in costs. See Note 15.
17. Data for WellPoint health plan participants were collected and analyzed by the WellPoint actuarial team
18. The data are not yet risk-adjusted. In addition, they are based on medical claims only; pharmacy claims are excluded.
19. This was the only analysis that was done by WellPoint. The comprehensive analysis is being done by Brandeis University, which hopes to complete its analyses by the end of 2012.
20. Berwick DM, Nolam TW, Whittington J. The Triple Aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-69.