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Bending the cost curve? Results from a comprehensive primary care payment pilot
University of Massachusetts Medical School Faculty Publications
  • Sonal Vats, Boston University
  • Arlene S. Ash, University of Massachusetts Medical School
  • Randall P. Ellis, Boston University
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
Document Type
Adult; Aged; Algorithms; Female; Health Expenditures; Humans; Insurance Claim Review; Insurance Coverage; Insurance, Health; Male; Massachusetts; Medicaid; Medicare; Middle Aged; Patient-Centered Care; Primary Health Care; Propensity Score; Risk Adjustment; United States

BACKGROUND: There is much interest in understanding how using bundled primary care payments to support a patient-centered medical home (PCMH) affects total medical costs.

RESEARCH DESIGN AND SUBJECTS: We compare 2008-2010 claims and eligibility records on about 10,000 patients in practices transforming to a PCMH and receiving risk-adjusted base payments and bonuses, with similar data on approximately 200,000 patients of nontransformed practices remaining under fee-for-service reimbursement.

METHODS: We estimate the treatment effect using difference-in-differences, controlling for trend, payer type, plan type, and fixed effects. We weight to account for partial-year eligibility, use propensity weights to address differences in exogenous variables between control and treatment patients, and use the Massachusetts Health Quality Project algorithm to assign patients to practices.

RESULTS: Estimated treatment effects are sensitive to: control variables, propensity weighting, the algorithm used to assign patients to practices, how we address differences in health risk, and whether/how we use data from enrollees who join, leave, or change practices. Unadjusted PCMH spending reductions are 1.5% in year 1 and 1.8% in year 2. With fixed patient assignment and other adjustments, medical spending in the treatment group seems to be 5.8% (P=0.20) lower in year 1 and 8.7% (P=0.14) lower in year 2 than for propensity-weighted, continuously enrolled controls; the largest proportional 2-year reduction in spending occurs in laboratory test use (16.5%, P=0.02).

CONCLUSIONS: Although estimates are imprecise because of limited data and quasi-experimental design, risk-adjusted bundled payment for primary care may have dampened spending growth in 3 practices implementing a PCMH.

  • UMCCTS funding
DOI of Published Version
Vats S, Ash AS, Ellis RP. Bending the cost curve? Results from a comprehensive primary care payment pilot. Med Care. 2013 Nov;51(11):964-9. doi:10.1097/MLR.0b013e3182a97bdc. Link to article on publisher's site
Related Resources
Link to article in PubMed
PubMed ID
Citation Information
Sonal Vats, Arlene S. Ash and Randall P. Ellis. "Bending the cost curve? Results from a comprehensive primary care payment pilot" Vol. 51 Iss. 11 (2013) ISSN: 1537-1948
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