PATIENT-CENTERED MEDICAL HOME, HEALTHCARE UTILIZATION, AND EXPENDITURES FOR OLDER CANCER SURVIVORS

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. Multivariable analyses were performed to examine the effects of the PCMH on healthcare utilization and expenditures. Results: 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: 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 reform regarding the effects of the PCMH and its components on healthcare utilization and expenditures.