The Patient-Centered Medical Home, Healthcare Utilization, and Expenditures for Older Cancer Survivors: A Quantitative Analysis
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Date
2016-01-01
Type of Work
Department
Gerontology
Program
Gerontology
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Distribution Rights granted to UMBC by the author.
Distribution Rights granted to UMBC by the author.
Abstract
Purpose: The Patient-Centered Medical Home (PCMH) model has been proposed to improve healthcare delivery and decrease costs. This study examined the associations between receipt of care consistent with a PCMH and the healthcare utilization and expenditures among older cancer survivors. Design and Methods: Secondary data analysis was conducted using data from the Medical Expenditure Panel Survey (MEPS). The study sample included adults aged 65 and over who had ever been diagnosed with cancer. The analytical datasets were constructed in two ways: a cross-sectional sample of MEPS 2008 to 2013, and a panel sample of MEPS Panels 13 to 17. The prevalence of the PCMH was examined. Multivariable analyses were performed to examine the effects of the PCMH on healthcare utilization and expenditures. Sensitivity analyses were conducted using sample of all older adults. Results: The prevalence of the PCMH increased with some fluctuation in recent years. Starting from 21.26% in 2008, the lowest prevalence of the PCMH was 20.23% in 2009, and the highest prevalence of the PCMH was 25.07% among older cancer survivors in 2013. The PCMH was significantly associated with higher likelihood of having ED visits and outpatient visits. Among the PCMH domains, comprehensive care and compassionate care was significantly associated with more outpatient visits, having a usual source of care was associated with more office based visits, and accessibility was significantly associated with less total expenditures and less Medicare expenditures. Implications: It is important to identify how the PCMH and its components impact healthcare outcomes. Primary care practices may not need to have all PCMH features to achieve improved healthcare outcomes. Future payment reform could consider incentivizing medical practices that adopt part of the cost-saving PCMH features and facilitate the progression of the implementation of a full PCMH model. Since the PCMH model is expected to adapt to a Medicare payment system that values the quality of care, aligns performance measures and incorporates value-based reimbursement, findings of this study inform the Medicare payment reform regarding the effects of the PCMH and its components on healthcare utilization and expenditures among older cancer survivors and older adults.