Association Between Extending CareFirst's Medical Home Program to Medicare Patients and Quality of Care, Utilization, and Spending

Association Between Extending CareFirst's Medical Home Program to Medicare Patients and Quality of Care, Utilization, and Spending

Published: Sep 01, 2017
Publisher: JAMA Internal Medicine, vol. 177, no. 9
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Associated Project

HCIA Evaluations: Primary Care Redesign

Time frame: 2013-2017

Prepared for:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services

U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation

Authors

G. Greg Peterson

Kristin Lowe Geonnotti

Lauren Hula

Timothy Day

Kate Stewart

Lorenzo Moreno

Key Findings
  • In a difference-in-differences analysis with 52 intervention practices and matched comparison practices, the program was not associated with outcome improvements for Medicare patients.
  • Hospitalizations declined by 10%, but this was matched by similar changes in the comparison group, suggesting that outside market factors drove the decline in the treatment group.
  • The extension of CareFirst’s program to Medicare did not measurably improve quality-of-care processes or reduce service use or spending for Medicare patients.
  • Further program refinement and testing are needed to support scaling the program more broadly to Medicare patients.

CareFirst, the largest commercial insurer in the mid-Atlantic Region of the United States, runs a medical home program focusing on financial incentives for primary care practices and care coordination for high-risk patients. From 2013 to 2015, CareFirst extended the program to Medicare fee-for-service (FFS) beneficiaries in participating practices. If the model extension improved quality while reducing spending, the Centers for Medicare and Medicaid Services could expand the program to Medicare beneficiaries broadly.

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