reports

Evaluation of the Maryland Multi-Payer Patient Centered Medical Home Program

First Annual Report. Baltimore, MD, USA: Maryland Health Care Commission.

IMPAQ International, Columbia, MD, USA

The Maryland Health Care Commission (MHCC), an agency of the State of Maryland, launched the Maryland Multi-Payer Patient Centered Medical Home Program (MMPP) on April 14, 2011, as a three-year pilot in response to a legislative mandate enacted in 2010. The MHCC selected 53 practices to participate in the demonstration and created the Maryland Learning Collaborative (MLC) to provide education, technical assistance, and customized coaching to help practices transform into patient centered medical homes (PCMHs).

The goals of the MMPP are to improve the health and satisfaction of patients and to slow the growth of health care costs in Maryland, while supporting the satisfaction and financial viability of primary care providers in the state. The MHCC contracted with IMPAQ to conduct an assessment of whether the MMPP achieves these goals and also reduces health disparities. In addition, the evaluation assesses the practice transformation process and the benefits received by practices from shared savings.

To achieve these goals, the MHCC defined the following overarching research questions:

·         Will the PCMH program improve access to, and delivery of, health care?
·         Does the PCMH program improve the quality of care, particularly with regard to prevention and chronic care management?
·         Does the PCMH program lower the cost of care through reduced utilization?
·         Does the PCMH program reduce health disparities?
·         Are patients more satisfied in a PCMH?
·         Are physicians and other clinical staff more satisfied in a PCMH?

IMPAQ’s evaluation is both quantitative and qualitative in nature and consists of several components, including interviews with participating practices, administrative data analysis, and patient and provider surveys. To examine the research questions, the evaluation consists of three parts. IMPAQ is assessing the following areas: (1) access, quality, utilization, disparities, and cost outcomes, using administrative data; (2) implementation and practice transformation, using interviews, site visits, and administrative data; and (3) satisfaction among patients and providers, using surveys. The administrative data and provider survey analyses use two comparison groups: one group that appeared to be largely unexposed to the PCMH concept and the other composed of practices participating in the CareFirst BlueCross BlueShield PCMH program.

This report provides interim analysis results about the progress of MMPP implementation. In particular, it provides baseline information on the transformation of sites and on patient and provider satisfaction with the program and also compares the 2011 analysis measures to the baseline measures (2010). Since primary data collection occurs at the beginning and end of the program, this report provides only baseline analyses for transformation and program satisfaction. However, the program outcome measures of quality, utilization, and cost of care are constructed from the administrative data, which are supplied annually. Thus, some early trends of the results of MMPP implementation could be analyzed.

While the analysis period covered by this report is early in the life of the MMPP, the analysis suggests that MMPP will achieve some of its goals. The findings from the first year are outlined below.

·         Program Implementation

o      Practices that operated on a smaller scale reported more success in implementing transformation elements and involving providers and staff in transformation processes. This was also seen in the quantitative analysis of recognition levels.
o      The affiliation with a hospital positively affected practices’ ability to transform, particularly in terms of staff resources and the ability to coordinate care.
o      Structured PCMH oversight teams working in conjunction with PCMH champions served as an important element of success.

·         Patient Satisfaction

o      Patients are generally pleased with the care they received from MMPP participating providers.
o      Although there were few statistically significant differences, generally the more vulnerable populations (African-American, Medicaid, and patients with chronic conditions) rated their provider or practice more highly.
o      For patients with chronic conditions, providers pay attention to their mental health, discuss medication decisions with them, how well providers communicate with patients, and the overall rating of the provider.

·         Provider Satisfaction

o      MMPP providers expressed greater satisfaction in their current job than the comparison group of PCMH providers.
o      At MMPP practices, medical assistants and administrative staff are more likely to take responsibility for some duties that clinicians perform in the comparison practices.
o      Providers in the MMPP group, however, were more likely to feel that their compensation plans rewarded hard workers and that the business office and administration are valued by the practice.

·         Program Outcomes

MMPP practices/patients experienced:

o      Larger decrease in the proportion of young adults with a hospital admission due to asthma
o      A relative increase in the annual rates of well-care visits among adolescents
o      An increase in the proportion of patients with one or more office visits to the attributed primary care physician
o      A decrease in the mean number of specialist office visits among patients with such visits
o      A relative decrease in total outpatient payments
o      A relative decrease in total other payments (excluding inpatient, outpatient, emergency department, office visits, home health, nursing home, hospice, radiology, and lab).

In addition, over time the patients who maintained the PCMH affiliation in both years had higher gains in the program outcome where the MMPP had an impact.