Care continuity in a patient-centered medical home setting

Abstract

The patient-centered medical home (PCMH) is a health system innovation aimed to improve cost, quality, and health outcomes. Research shows that Medicare beneficiaries at practices with PCMH recognition have lower Medicare costs than those at practices without such recognition. Our study explores whether greater care continuity—an ongoing relationship between the patient and clinicians at a practice that monitors the patient’s health status and care—drives these lower costs in PCMH-recognized practices. We used Medicare Parts A and B claims data to calculate Medicare payments for services. We conducted weighted least squares regression analyses at the practice level to examine the association of Medicare payments with PCMH recognition and care continuity. We measured care continuity using an index that reflects the concentration of visits in the practice that serves as the beneficiary’s usual source of care. Medicare beneficiaries at PCMH-recognized practices had lower total annual Medicare payments (-$1,099; p < 0.01) than patients at nonrecognized practices. After controlling for care continuity, the association with PCMH recognition decreased substantially and beneficiaries in practices with high (compared to low) care continuity had significantly lower total payments (-$1,872, p = 0.02). Evidence from this study indicates that care continuity is a key driver of cost reductions associated with PCMH recognition.