The Reduction in and Hospital Admissions in Medical Home Practices Is Specific to Primary Care–Sensitive Chronic Conditions

Objective

To determine whether the Patient‐Centered Medical Home (PCMH) transformation reduces hospital and utilization, and whether the effect is specific to chronic conditions targeted for management by the in our setting.

Data Sources and Study Setting

All patients aged 18 years and older in 2,218 primary care practices participating in a statewide incentive program sponsored by Blue Cross Blue Shield of Michigan () in 2009–2012.

Study Design

Quantitative observational study, jointly modeling ‐targeted versus other hospital admissions and visits on score, patient, and practice characteristics in a hierarchical multivariate model using the generalized gamma distribution.

Data Collection

Claims data and PCMH scores held by BCBSM.

Principal Findings

Both hospital and utilization were reduced proportionately to score. Hospital utilization was reduced by 13.9 percent for ‐targeted conditions versus only 3.8 percent for other conditions ( = .003), and utilization by 11.2 percent versus 3.7 percent ( = .010). Hospital cost was reduced by 17.2 percent for ‐targeted conditions versus only 3.1 percent for other conditions ( < .001), and cost by 9.4 percent versus 3.6 percent ( < .001).

Conclusions

PCMH transformation reduces hospital and ED use, and the majority of the effect is specific to PCMH ‐targeted conditions.