Impact of Medical Homes on Expenditures and Utilization for Beneficiaries With Behavioral Health Conditions
Impact of Medical Homes on Expenditures and Utilization for Beneficiaries With Behavioral Health Conditions
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DOI：
10.1176/appi.ps.201700433
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发表时间：
2018-08-01
影响因子：
3.8
通讯作者：
Kim, Konny
中科院分区：
文献类型：
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作者：
Romaire, Melissa A.;Keyes, Vincent;Kim, Konny
目的：有行为健康问题的个人可以从以患者为中心的医疗之家(PCMH)提供的加强护理管理中受益。2011年底和2012年初，联邦医疗保险开始通过多支付者高级初级保健实践(MAPCP)示范，在8个州参与PCMH倡议。这项研究考察了这些计划如何满足有行为健康状况的患者的需求，以及示范对这一人群的支出和利用的影响。方法：半结构化访谈提供了各州改善医疗保健的方法，并使用联邦医疗保险和医疗补助索赔数据的多变量差异回归来模拟利用和支出的变化，比较MAPCP示范实践中具有行为健康状况的联邦医疗保险和医疗补助受益者与非初级保健实践中的类似受益者。利用包括所有原因的住院和急诊科就诊，行为健康状况和行为健康状况的门诊就诊。支出结果包括所有服务和主要诊断为行为健康状况的支出。结果：实践报告报告筛查更多的患者的行为健康状况，将患者与基于社区的行为健康资源联系起来，并聘请行为健康专家提供护理。几个州开始了独特的举措，以改善获得行为健康服务的机会。然而，参与MAPCP的演示和利用与行为健康服务的支出之间几乎没有发现显著的关联。结论：尽管PCMH共同努力改善了他们的行为健康患者获得护理的机会，但护理模式几乎没有实质性的变化。
Objective: Individuals with behavioral health conditions may benefit from enhanced care management provided by a patient-centered medical home (PCMH). In late 2011 and early 2012 Medicare began participating in PCMH initiatives in eight states through the Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration. This study examined how the initiatives addressed the needs of patients with behavioral health conditions and the impacts of the demonstration on expenditures and utilization for this population.Methods: Semistructured interviews provided insight into states' approaches to improving care, and multivariate difference-in-difference regressions of Medicare and Medicaid claims data were used to model changes in utilization and expenditures, comparing Medicare and Medicaid beneficiaries with behavioral health conditions in MAPCP demonstration practices with similar beneficiaries in non-PCMH primary care practices. Utilization included inpatient admissions and emergency department visits for all causes and for behavioral health conditions and outpatient visits for behavioral health conditions. Expenditure outcomes included expenditures for all services and those with a principal diagnosis of a behavioral health condition.Results: Practices reported screening more patients for behavioral health conditions, linking patients to community-based behavioral health resources, and hiring behavioral health specialists to provide care. Several states embarked on unique initiatives to improve access to behavioral health services. However, few significant associations were found between participation in the MAPCP demonstration and utilization and expenditures for behavioral health services.Conclusions: Even though PCMHs made concerted efforts to improve access to care for their patients with behavioral health conditions, few substantial changes in patterns of care were noted.