This Commonwealth Fund report examines the relationship between medical practices’ costs and medical home activities, finding that medical homes were associated with modest information technology cost increases, but no other additional costs.  However, the authors acknowledge that the absence of a clear association between the level of medical home implementation and practice cost may stem from data limitations or an insufficient definition of “medical home”.

From the Executive Summary:

Based on data from the 35 practices in the final analysis sample, we found no evidence of additional costs associated with higher levels of MH activity; our estimates suggested that there was less than a $1-per-month difference in patient costs between the third of study practices with the highest PPC-PCMH scores (which measure MH intensity) and those in the middle and lower thirds. The average total cost per full-time-equivalent (FTE) physician was $517,000 for all 35 practices. Although the mean total cost per FTE physician increased slightly across the three score categories, the Low and High means were within one standard error of one another, meaning that the differences were not statistically significant. Support staff costs exhibited a similar pattern.

The Commonwealth Fund. (2009). Incremental cost estimates for the patient-centered medical home. Zuckerman, Stephen, Merrell, Katie, Berenson, Robert, Gans, David, Underwood, William, Williams, Aimee, Erickson, Shari & Hammons, Terry.

Full report: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2009/Oct/1325_Zuckerman_Incremental_Cost_1019.pdf

This article examined the impact of Medicaid managed care organizations on health care access for disabled adults, finding that managed care enrollees were 30 percent more likely to have long wait times prior to see a provider, 32 percent more likely to report problems accessing specialist care, and 10 percent less likely to receive a flut shot.  

Burns, M. E. (2009). Medicaid managed care and health care access for adult beneficiaries with disabilities.  Health Services Research, 44(5), 1521-1541. DOI: 10.1111/j.1475-6773.2009.00991.x http://www.hsr.org/hsr/abstract.jsp?aid=44434898469 

Authors: Marguerite E. Burns.

The Urban Institute explores the possible impacts that accountable care organizations (ACOs) could have on the cost-effectiveness and quality of care delivered by Medicare funds.

From the abstract:

Experts agree that the way health care is currently paid for in the United States, especially in the traditional, fee-for-service Medicare program, does not support coordinated care that is high quality and cost-efficient. To address these problems, policy-makers are taking a close look at accountable care organizations (ACOs).

This policy brief explores what ACO are, how they compare to previous reform concepts such as Health Maintenance Organizations and Provider Sponsored Organizations, key design and implementation issues, and opportunities and challenges.

The authors conclude that ACOs are no real game changers in the short term, but are nevertheless important to try.

The Urban Institute. (2009). Can accountable care organizations improve the value of health care by solving the cost and quality quandaries? Devers, Kelly & Berenson, Robert A.

Full report: http://www.urban.org/publications/411975.html

This report prepared for the Center for Health Care Strategies builds on research conducted by Mathematica Policy Research on primary care case management programs (PCCM) in five states.

From the summary: 

Center for Health Care Strategies (CHCS). (2009). Enhanced primary care case management in Medicaid: issues and options for states. Verdier, James M., Byrd, Vivian, Stone, Christal.

Full report: http://www.chcs.org/publications3960/publications_show.htm?doc_id=1013920

From the introduction:

Predictive models are data-driven, decision-support tools that estimate an individual’s future potential health care costs and/or opportunities for care management. Most commercially available PM tools classify individuals into future cost categories with a focus on high-cost cases. A few tools add a second component — commonly referred to as “impactability” — to identify patients who will potentially benefit from care management. Adapting PM tools to address the Medicaid population’s intense and complex array of needs — ranging from physical and behavioral health comorbidities to socioeconomic issues — is a critical consideration for states that are planning to use PM. This holds true for states buying off-the-shelf tools as well as those with the analytical capabilities to build and/or customize PM tools in-house.

Center for Health Care Strategies, Inc. (2009). Predictive modeling: a guide for state Medicaid purchasers. Dave Knutson, Melanie Bella and  Karen Llanos.

Full report: http://www.chcs.org/usr_doc/Predictive_Modeling_Guide.pdf

This toolkit, created by CHCS’ Collaborative on Improving Managed Care Quality for Youth with Serious Behavioral Health Needs, offers best practices implemented by managed care organizations (MCOs), challenges and lessons learned, and opportunities for continued innovations in care for children and youth with serious behavioral health needs.

From CHCS:

Although Medicaid managed care programs are covering children with serious behavioral health disorders, limited funds for program evaluation have prevented most from examining their impact on children’s behavioral health care. The 10-year, SAMHSA-funded Health Care Reform Tracking Project found that in roughly 45% of Medicaid managed care programs, the impact of managed care on children’s behavioral health care (e.g., service utilization, quality, cost, and family satisfaction) was unknown, and in 63% of programs, impact on clinical and functional outcomes was unknown. Notably, SAMHSA found that the Medicaid fee-for-service system did not provide such data either. 16 This Collaborative provided a timely opportunity for participating MCOs to look more closely at their data for this population, and develop new data to inform and track quality enhancements.

Center for Health Care Strategies, Inc. (2009). Improving Medicaid managed care for youth with serious behavioral health needs: a quality improvement toolkit. Kamala Allen and Sheila A. Pires.

Full toolkit: http://www.chcs.org/usr_doc/Improving_Medicaid_Managed_Care_for_Youth_with_Serious_Behavioral_Health_Needs_Toolkit.pdf