Do Medical Homes Improve Quality of Care for Persons with Multiple Chronic Conditions?

Karen E Swietek, Marisa Elena Domino, Christopher Beadles, Alan R Ellis, Joel F Farley, Lexie R Grove, Carlos Jackson, C Annette DuBard


Objective: To examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC).

Data sources/study setting: Secondary claims data from fiscal years 2008-2010. The sample included nonelderly Medicaid beneficiaries with at least two of eight target conditions (asthma, chronic obstructive pulmonary disease, diabetes, hypertension, hyperlipidemia, seizure disorder, major depressive disorder, and schizophrenia).

Study design: We used linear probability models with person- and year-level fixed effects to examine the association between patient-centered medical home (PCMH) enrollment and nine disease-specific quality-of-care metrics, controlling for selection bias and time-invariant differences between enrollees.

Data collection methods: This study uses a dataset that links Medicaid claims with other administrative data sources.

Principal findings: Patient-centered medical home enrollment was associated with an increased likelihood of receiving eight recommended mental and physical health services, including A1C testing for persons with diabetes, lipid profiles for persons with diabetes and/or hyperlipidemia, and psychotherapy for persons with major depression and persons with schizophrenia. PCMH enrollment was associated with overuse of short-acting β-agonists among beneficiaries with asthma.

Conclusions: The PCMH model can improve quality of care for patients with multiple chronic conditions.

This article was featured on the December 7, 2021, Lunch and Learn discussion

In this segment of the recording of the recording, Dr. Karen Swietek, PhD, senior health economist at NORC presented the paper. 

Summary Discussion Highlights:

  • In 2018, over 50% of adults in the United States reported having at least one chronic condition and more than a quarter had at least two. Research has shown that having multiple chronic conditions is associated with poor health outcomes, a higher risk of death and higher healthcare costs. Managing chronic conditions accounts for about 75 cents of every dollar spent on health care services in the US.
  • Medical Home enrollees are more likely to receive almost all process-based quality of care metrics for both physical (diabetes and hypertension) and behavioral health conditions (depression and schizophrenia).
  • The medical home is an effective way to improve quality of care for patients with multiple chronic conditions. There is a sizeable and growing body of research demonstrating the medical home can improve quality for conditions that require long term management due to its team-based structure and emphasis on coordination of care.
  • Payment reform needs to catch up and we should be incentivizing this model of care delivery.
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