Pennsylvania’s Medical Home Initiative: Reductions in Healthcare Utilization and Cost Among Medicaid Patients with Medical and Psychiatric Comorbidities

The Chronic Care Initiative (CCI) was a large state-wide patient-centered medical home (PCMH) initiative in Pennsylvania in place from 2008–2011. At its height, it included 783 providers and served more than 1.18 million patients. Evaluation of the program, in terms of quality, utilization, and cost outcomes has been mixed. This study assessed whether the CCI had an impact on the utilization and costs for Medicaid patients with chronic medical conditions and comorbid psychiatric or substance use disorders. The investigators analyzed Medicaid claims to compare changes in utilization and costs for 11,105 patients in 96 CCI practices compared to an equal number of patients in 60 matched non-CCI practices. Using a difference-in-difference approach, they measured changes in total per patient costs one year before and one year after an index claim. Relative to the non-CCI group, the CCI group experienced an average adjusted cost savings of $4,145 per patient per year. This was largely driven by a $3,521 savings in inpatient medical costs, in addition to relative savings in outpatient psychiatric ($21.54) and substance abuse service costs ($16.42). The CCI group had relative reductions in ED utlization and psychiatric hospitalizations. The investigators conclude that the CCI was associated with substantial cost savings and identifiable changes in health care utilization for this high-risk group of Medicaid patients.These findings suggest that the PCMH may be especially beneficial among patients with chronic physical and behavioral health conditions. More research is needed to understand its impact on quality of care and overall cost-effectiveness.

This research was funded by the Robert Wood Johnson Foundation (RWJF) through its State Health Access Reform Evaluation (SHARE) Initiative.