1 / 19

Oregon’s Patient Centered Primary Care Home Model after Three Years: Use and Expenditures

This study assesses the impact of Oregon's PCPCH program on healthcare use and expenditures over a three-year period. It examines the program's effects on covered services and key service types, as well as overall program outcomes based on duration of PCPCH designation.

craftd
Download Presentation

Oregon’s Patient Centered Primary Care Home Model after Three Years: Use and Expenditures

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Oregon’s Patient Centered Primary Care Home Model after Three Years: Use and Expenditures Neal Wallace, Ph.D. Shauna Petchel, MPH Portland State University Research Support from the Oregon Health Authority (PI: Sherril Gelmon, DrPH)

  2. Background • The Oregon Legislature established the Patient-Centered Primary Care Home (PCPCH) Program in 2009 to create access to patient-centered, high quality care and reduce costs by supporting practice transformation. • The PCPCH model is Oregon’s characterization of a “medical home,” and is defined by six core attributes each with a number of corresponding standards and measures. • The attributes include: Access to Care; Accountability; Comprehensive Whole-Person Care; Continuity; Coordination and Integration; and Person and Family Centered Care. • The Program is responsible for defining the model, administering the application process to recognize practices that have achieved the model, and providing technical assistance to clinics. • As of December 2015, over 600 practices across the state had been formally recognized by the OHA as a PCPCH.

  3. Research Objective • To assess the impact of Oregon’s Patient Centered Primary Care Home (PCPCH) program on use and expenditures: • For all PCPCH designated clinics through the first three years of the program • Across all covered services and key service types • For the program overall and by PCPCH duration of designation.

  4. Study Design • Generalized difference-in-difference design to accommodate staggered PCPCH implementation: • Compare patients empirically attributed to PCPCH or non-PCPCH primary care providers in each study year • Minimum one year pre-PCPCH data and maximum three years post PCPCH designation • Applied to a two part model to assess probability of use, expenditures per user and per person

  5. Study Data • Four years of Oregon All Payer All Claims (APAC) claims, eligibility and provider data: • October 2010 through September 2014 (first PCPCH designations October 1, 2011) • APAC contains all claims for commercial, self-insured, Medicaid, and Medicare Advantage • Does not include Medicare FFS, VA claims • Excludes substance use and some sensitive condition (e.g. AIDS/HIV) related service claims

  6. Study Population - Individuals • 1,192,435 individuals were initially identified who during a study year had: • Consistent residence in Oregon • Consistent, full year insurance coverage • At least one primary care visit to an Oregon provider • These individuals were empirically attributed to a provider billing unit during each study year based on plurality of visits or last visit (tie) • The final study population consists of 1,128,234 individuals solely (100%) attributed to either PCPCH or non-PCPCH primary care provider billing units (606,881 PCPCH and 599,990 non-PCPCH)

  7. Study Population - Providers • 510 PCPCH practices continuously designated within the study period (on or after October 2011) • PCPCH related claims were initially identified using practice and/or organizational National Provider Identifiers (NPIs). • NPI-based claims were grouped using a “provider crosswalk key”: • Practice billing units reflecting common/linking billing information (e.g. name, address, secondary NPI, etc). • Links practitioners billing under individual NPI but otherwise identifying as part of larger practice group • Practices may have multiple “billing units”

  8. Study Population - Observations • The unit of analysis for the study was a provider billing unit quarter. • Individual use, expenditure and demographic characteristics were aggregated to provider billing unit by quarter • 100,084 observations (7,380 PCPCH/92,704non-PCPCH) representing 510 PCPCH and 8,435 non-PCPCH billing units

  9. Outcome Measures • Main outcome measures are percentage of subjects using service in a quarter, expenditures per service user, and expenditures per subject • The outcome measures are applied to all covered services and eight specific service types: • Primary care office visits and procedures • Specialty office visits and procedures • Outpatient mental health care • Non-therapeutic radiation • Lab • Pharmacy • Emergency Department • Inpatient

  10. Subject Characteristics • Subject characteristics aggregated to the practice billing unit quarter as percentages include: • Gender • Age group (9) • Specific insurance type (16) • Physical and behavioral condition markers (10) including diabetes, COPD/asthma, chronic heart failure, chronic kidney disease, coronary heart disease, cerebrovascular disease, obesity, schizophrenia, affective disorders, and other behavioral health conditions

  11. Analytic Methods • Two-way fixed effects (practice billing unit and quarter) weighted (individuals) OLS regression • Inclusion of all subject characteristics measures • Samples are not matched but >99% support found across PCPCH and non-PCPCH observations • PCPCH effects identified by a binary variable(s): • For all PCPCH related quarterly observations on or after PCPCH designation date, or • PCPCH designated quarters by year of designation (1-3) • Standard errors adjusted for clustering on practice billing unit

  12. Results: Subject Characteristics

  13. Results: Expenditures per Person

  14. Results: Expenditures per User

  15. Results: Percent Service Use

  16. Results: Summary • Total expenditures were reduced by 4% overall with progressive reductions to 8% for PCPCHs in the third year of designation: • Progressive decreases in overall expenditure per user coupled with progressive increases in overall service use • Increases in primary care expenditure and use • Reductions in specialty care expenditures and use • No or inconsistent change in lab and radiology • Increases in expenditure and use of pharmacy • Decreases in expenditures for ED and inpatient: • All due to decreases in expenditures per user – use up (ED) or unchanged (IP)

  17. Study Limitations • PCPCH program effects may be Oregon specific (e.g. culture of “transformation”) • PCPCH practices have different characteristics than non-PCPCH and may reflect unique capabilities/motivations of practices that chose to participate • APAC data missing some key services (e.g. substance abuse) and insurance groups (e.g. Medicare FFS) • Observational, natural experiment design may fail to capture “unobservables” that influence outcomes • Current design does not adjust for potential differences in reimbursement rates across insurance types over time • Anticipatory behavior by PCPCHs (changes prior to designation) detected

  18. Conclusions • Oregon’s Patient Centered Primary Care Home Program appears to be incurring expected (or hoped for) system transformative effects – reducing expenditures in a “treatment positive” manner • Findings are consistent with other large state level implementation efforts – e.g. Colorado and Michigan • Apparent progressive effects among PCPCHs over time from designation may be important to understand from a policy, programmatic and evaluation standpoint: • Policy makers may actually have to wait for large(r) results • Progressive effects could be practice maturation (consistent with Oregon’s multi-level designation approach) and/or “dose response” as patients get more exposure to program. • Some effects may not be apparent in short-term or “average” effect evaluations

  19. Questions? Thank You nwallace@pdx.edu Mark O. Hatfield School of Government OHSU/PSU Joint School of Public Health Portland State University

More Related