Fakeye, Oludolapo A.Hsu, Yea-JenWeiner, Jonathan P.Marsteller, Jill A.2024-01-222024-01-222023-12-04Fakeye, Oludolapo, Yea-Jen Hsu, Jonathan Weiner, and Jill Marsteller. “Impact of the Patient-Centered Medical Home on Consistently High-Cost Patients,” December 2023, 29 (December 4, 2023). https://www.ajmc.com/view/impact-of-the-patient-centered-medical-home-on-consistently-high-cost-patients.https://doi.org/10.37765/ajmc.2023.89467http://hdl.handle.net/11603/31395Objective: To evaluate the effect of a statewide multipayer patient-centered medical home (PCMH) demonstration on patients consistently within the highest ranks of health services expenditure across Maryland. Study Design: Post hoc longitudinal analyses of administrative data on privately insured patients of medical homes that participated in the Maryland Multi-Payer PCMH Program (MMPP), matched for comparison to medical homes in a single-payer PCMH program and to non-PCMH practices. Methods: Consistently high-cost patients (CHPs) were defined as being in the top statewide quintile of payer expenditure over a 2-year baseline period. Using population-averaged generalized linear regression models, we evaluated the odds of CHPs remaining in the highest-cost quintile during the 2-year MMPP implementation period and assessed changes in their utilization patterns. Results: Six percent of included patients were CHPs and accounted for one-third of total expenditure. For CHPs in multipayer PCMHs, estimated odds of remaining in this status after 2 years were lower by 34% (adjusted OR [AOR], 0.66; 95% CI, 0.41-0.90; P = .03) relative to CHPs in non-PCMH practices and higher by 41% (AOR, 1.41; 95% CI, 1.08-1.75; P = .004) compared with CHPs in single-payer PCMHs. Relative to CHPs in non-PCMH practices, CHPs in multipayer PCMHs had inpatient admissions decline by 40% (incidence rate ratio [IRR], 0.60; 95% CI, 0.36-1.00; P = .049) and visits to the attributed primary care provider increase by 21% (IRR, 1.21; 95% CI, 1.05-1.39; P = .01). Conclusions: Relative to routine primary care, the PCMH model significantly reduces the probability that CHPs remain in this expensive category and enhances continuity of care.en-USThis item is likely protected under Title 17 of the U.S. Copyright Law. Unless on a Creative Commons license, for uses protected by Copyright Law, contact the copyright holder or the author.patient-centered medical home (PCMH)highest ranks of health services expenditure across MarylandMaryland Multi-Payer PCMH Program (MMPP)Consistently high-cost patients (CHPs)Text