Dr. Janet M. Bronstein, professor in the department of health care organization and policy and senior scholar in the Lister Hill Center for Health Policy at the University of Alabama at Birmingham School of Public Health, recently led a study to estimate the effects of primary care medical home support on the use of clinical services and Medicaid expenditures in Alabama. UAB co-investigators are department colleagues professor Dr. Bisakha Sen, and professor emeritus Dr. Michael A. Morrisey; as well as program manager Ms. Sally Engler, in the department of acute, chronic and continuing care, and statistical analyst Mr. Wilson K. Smith in the department of medicine.
[Photo: Dr. Janet M. Bronstein]
The study design was a difference-in-differences model where changes in utilization and expenditures of the intervention group were compared with changes in the nonintervention group. Using Medicaid claims from October 2010 through September 2013, service use and expenditures were measured for 12 months before and 21 months after implementation. Changes for four health status groups were examined separately.
Findings indicated that the introduction of community-based support was associated with a small reduction in service use and no statistically significant overall effect on expenditures. However, among patients with chronic and/or mental health conditions, there were modest, statistically significant increases in use of and expenditures for a range of ambulatory and inpatient health care services, while service use for those without these conditions declined. Emergency department use increased for all groups.
Dr. Bronstein and her colleagues concluded that community-based support for medical home physician practices is associated with a shift in the service mix provided to higher cost, more vulnerable subgroups in Medicaid. Such systems are unlikely to be associated with significant overall cost savings, at least in the short term, but do appear to increase linkages to care for enrollees with significant health care needs. The Medical Home program recently expanded statewide, and is now available to all high risk Alabama medicaid enrollees and their physicians.
“Initial Impacts of the Patient Care Networks of Alabama Initiative” was published online in June 2015 in the journal Health Services Research.