Research Objective: The patient centered medical home (PCMH) is increasingly being implemented in an effort to improve and coordinate primary care, but its effect on health care utilization among breast cancer survivors remains unclear. The objective of this study was to examine health care utilization and expenditures as a function of PCMH enrollment among breast cancer survivors.
Study Design: North Carolina Medicaid claims linked to North Carolina Central Cancer Registry records (2003-2007) were used to examine monthly patterns of health care use and expenditures. Fixed effects regression models analyzed associations between PCMH enrollment and utilization of outpatient, inpatient, and emergency department (ED) services and Medicaid expenditures during the 15 months after breast cancer diagnosis, controlling for selection bias on time-invariant characteristics.
Population Studied: women with early breast cancer (stages 0-2, or unstaged disease) in North Carolina’s Medicaid program.
Principal Findings: Among 758 breast cancer survivors, 381 (50%) were enrolled in a PCMH at some time in the 15 months post-diagnosis. After controlling for individual and time fixed effects, PCMH enrollment was significantly associated with greater outpatient service use (0.52 more visits, p<0.001). However, there was no difference in the probability of inpatient hospitalizations or ED visits by PCMH status. Enrollment in a PCMH was associated with increased expenditures of $429 per month during the first 15 months. The effect on expenditures was not statistically significant when we analyzed costs up to 24 and 36 months post-diagnosis; the magnitude of the difference in monthly expenditures trended downward over time.
Conclusions: Greater outpatient care utilization and increased average expenditures among breast cancer survivors enrolled in a PCMH may suggest that these women have improved access to primary and specialty care.
Implications for Policy or Practice: Expanding PCMHs may change patterns of service utilization for Medicaid breast cancer survivors, but may not be associated with lower costs.
