How the PCMH Affected Inpatient and ED Utilization for Palmetto Health

Thursday, July 22nd, 2010
This post was written by Jessica Fornarotto

Marcus Barnes, the director for the Richland Care Medical Home for Palmetto Health, describes how the Richland Care Medical Home model affected patient and ED utilization.

The Richland Care Medical Home began serving Richland County residents in November of 2001. Since then, we have seen impressive results. There have been improvements in self-reported health status. We have also demonstrated improvements in inpatient utilization and ED utilization among our active participants.

Using the Primary Care Assessment Tools developed by Johns Hopkins School of Public Health, the percentage of survey participants self-reporting their health status as “good,” “very good” or “excellent” was 55.2 percent in 2001. In 2006, 67.1 percent of the survey participants indicated the same health status categories. These results show that access to these services has a positive effect on the health of participants.

Utilization results helped us show how the PCMH model is affecting the hospital system as a whole. Data was collected from the South Carolina Office of Research and Statistics and area hospitals. The baseline data was created by reviewing the utilization for the two years prior for over 3,100 participants that were in the hospital system as self-pay. That was compared with the utilization of close to 11,000 participants from the start of the program in November 2001 to August 2006. The results were given in a per member per month (PMPM) figure. Only periods of active participants were used in the study.

Of the participants who were active in Richland Care, overall inpatient utilization was reduced by 15 percent during the 58-month period — from 0.0093 to 0.008 visits PMPM. The number of hospitalizations that did not occur for participants active in the program was 231 through that 58-month period. Trended results by year showed that the utilization of inpatient services increased slightly during the first year of Richland Care and then steadily declined between September 2002 and August 2005, by which time inpatient utilization had declined by 29 percent. Utilization rose slightly for the period of September 2005 to August 2006. An explanation for this increase was the influx of low-income, uninsured Hurricane Katrina evacuees needing access to hospital services in the fall and winter of 2005. During the first year, once this population gained access to these services, there was an increase, but after that there was a noticeable trend of decrease each year.

For active Richland Care participants, overall ED utilization was reduced by 36 percent over the 58-month period, resulting in 4,205 missed ED visits. Trended results by year show slight variation in the utilization of ED services. Like inpatient utilization, there is a slight increase in the utilization for the period of September 2005 through August 2006, potentially related to services needed by the Hurricane Katrina evacuees.

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