TY - JOUR
KW - Adult
KW - Attitude of Health Personnel
KW - Female
KW - Health Expenditures
KW - Humans
KW - Insurance Coverage/statistics & numerical data
KW - Insurance, Health/statistics & numerical data
KW - Male
KW - Maryland
KW - Medicaid/statistics & numerical data
KW - Patient Acceptance of Health Care/statistics & numerical data
KW - Patient Care Management/organization & administration
KW - Patient Satisfaction
KW - Patient-Centered Care/economics/organization & administration/standards
KW - Quality Indicators, Health Care
KW - Quality of Health Care/economics/organization & administration
KW - United States
AU - Jill A. Marsteller
AU - Yea-Jen Hsu
AU - Christine Gill
AU - Zippora Kiptanui
AU - Oludolapo A. Fakeye
AU - Lilly D. Engineer
AU - Donna Perlmutter
AU - Niharika Khanna
AU - Gail B. Rattinger
AU - Donald Nichols
AU - Ilene Harris
A1 - 
AB - OBJECTIVE: To evaluate impact of the Maryland Multipayor Patient-centered Medical Home Program (MMPP) on: (1) quality, utilization, and costs of care; (2) beneficiaries' experiences and satisfaction with care; and (3) perceptions of providers. DESIGN: 4-year quasiexperimental design with a difference-in-differences analytic approach to compare changes in outcomes between MMPP practices and propensity score-matched comparisons; pre-post design for patient-reported outcomes among MMPP beneficiaries. SUBJECTS: Beneficiaries (Medicaid-insured and privately insured) and providers in 52 MMPP practices and 104 matched comparisons in Maryland. INTERVENTION: Participating practices received unconditional financial support and coaching to facilitate functioning as medical homes, membership in a learning collaborative to promote education and dissemination of best practices, and performance-based payments. MEASURES: Sixteen quality, 20 utilization, and 13 cost measures from administrative data; patient-reported outcomes on care delivery, trust in provider, access to care, and chronic illness management; and provider perceptions of team operation, team culture, satisfaction with care provided, and patient-centered medical home transformation. RESULTS: The MMPP had mixed impact on site-level quality and utilization measures. Participation was significantly associated with lower inpatient and outpatient payments in the first year among privately insured beneficiaries, and for the entire duration among Medicaid beneficiaries. There was indication that MMPP practices shifted responsibility for certain administrative tasks from clinicians to medical assistants or care managers. The program had limited effect on measures of patient satisfaction (although response rates were low) and on provider perceptions. CONCLUSIONS: The MMPP demonstrated mixed results of its impact and indicated differential program effects for privately insured and Medicaid beneficiaries.
AD - Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.; IMPAQ International LLC, Columbia.; IMPAQ International LLC, Columbia.; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.; IMPAQ International LLC, Columbia.; Department of Family and Community Medicine (NK), University of Maryland School of Medicine, Baltimore, MD.; Department of Health Outcomes and Administrative Sciences (GBR), Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY.; RTI International (DN), Washington, DC.; IMPAQ International LLC, Columbia.
BT - Medical care
C5 - Financing & Sustainability; Healthcare Disparities; Medical Home
CP - 4
CY - United States
DO - 10.1097/MLR.0000000000000881
IS - 4
JF - Medical care
LA - eng
M1 - Journal Article
N2 - OBJECTIVE: To evaluate impact of the Maryland Multipayor Patient-centered Medical Home Program (MMPP) on: (1) quality, utilization, and costs of care; (2) beneficiaries' experiences and satisfaction with care; and (3) perceptions of providers. DESIGN: 4-year quasiexperimental design with a difference-in-differences analytic approach to compare changes in outcomes between MMPP practices and propensity score-matched comparisons; pre-post design for patient-reported outcomes among MMPP beneficiaries. SUBJECTS: Beneficiaries (Medicaid-insured and privately insured) and providers in 52 MMPP practices and 104 matched comparisons in Maryland. INTERVENTION: Participating practices received unconditional financial support and coaching to facilitate functioning as medical homes, membership in a learning collaborative to promote education and dissemination of best practices, and performance-based payments. MEASURES: Sixteen quality, 20 utilization, and 13 cost measures from administrative data; patient-reported outcomes on care delivery, trust in provider, access to care, and chronic illness management; and provider perceptions of team operation, team culture, satisfaction with care provided, and patient-centered medical home transformation. RESULTS: The MMPP had mixed impact on site-level quality and utilization measures. Participation was significantly associated with lower inpatient and outpatient payments in the first year among privately insured beneficiaries, and for the entire duration among Medicaid beneficiaries. There was indication that MMPP practices shifted responsibility for certain administrative tasks from clinicians to medical assistants or care managers. The program had limited effect on measures of patient satisfaction (although response rates were low) and on provider perceptions. CONCLUSIONS: The MMPP demonstrated mixed results of its impact and indicated differential program effects for privately insured and Medicaid beneficiaries.
PP - United States
PY - 2018
SN - 1537-1948; 0025-7079
SP - 308
EP - 320
EP - 
T1 - Maryland Multipayor Patient-centered Medical Home Program: A 4-Year Quasiexperimental Evaluation of Quality, Utilization, Patient Satisfaction, and Provider Perceptions
T2 - Medical care
TI - Maryland Multipayor Patient-centered Medical Home Program: A 4-Year Quasiexperimental Evaluation of Quality, Utilization, Patient Satisfaction, and Provider Perceptions
U1 - Financing & Sustainability; Healthcare Disparities; Medical Home
U2 - 29462077
U3 - 10.1097/MLR.0000000000000881
VL - 56
VO - 1537-1948; 0025-7079
Y1 - 2018
Y2 - Apr
ER -