Literature Collection

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.

OBJECTIVE: Individuals with serious mental illnesses represent a high-need, high-cost population. To address this population's needs under the State Innovation Models Initiative, Maine assisted Medicaid-participating behavioral health providers in changing to behavioral health homes (BHHs). The authors explored BHHs' experiences in transforming care from 2014 to 2017 and investigated changes in utilization, care coordination, and Medicaid expenditures before and after Medicaid-covered individuals enrolled in a BHH. METHODS: The authors interviewed stakeholders, conducted focus groups with BHH consumers and providers, and used pre-post analyses of Medicaid fee-for-service claims. Program features such as capitated payments, connection to the state's health information exchange, and one-on-one technical assistance altered delivery of behavioral health care. RESULTS: Interviewees reported some challenges, such as understanding team roles, sharing clinical data, and integrating care with primary care providers. Analyses of data for 7,560 BHH enrollees with serious and persistent mental illness (adults) or serious emotional disturbance (children) indicated no changes in inpatient admissions, 30-day inpatient readmissions, emergency department visits, behavioral health-related expenditures, and professional expenditures after the switch to the BHH model. Total Medicaid expenditures increased by $170 per beneficiary per month. The BHH model did not change several measures of utilization and expenditures, but it was well received by behavioral health providers. CONCLUSIONS: Medicaid programs experimenting with new care delivery models for individuals with complex conditions may look to the Maine experience for guidance in program design.