Table 2.

Total Visit Rates, New Patient Visit Rates, and Total Alternative Encounters Over Study Time Periods (Pre-APM, Pre-ACA; Post-APM, Pre-ACA; Post-APM Post-ACA)

OutcomeEncounters/1000 Patients per Month*Relative Rates
Pre-APMPost-APMPost-ACAPost-APM vs Pre-APMPost-ACA vs Post-APM
Total encounters
    APM clinics651.02672.82716.071.03 (0.98, 1.09)1.06 (0.98, 1.15)
    Non-APM comparison clinics435.10463.21480.331.07 (0.99, 1.13)1.04 (0.96, 1.12)
    APM vs Non-APM comparison relative rate0.97 (0.89, 1.05)1.03 (0.92, 1.15)
New patient visits
    APM clinics6.525.477.300.84 (0.60, 1.16)1.34 (0.86, 2.08)
    Non-APM comparison clinics4.945.125.351.04 (0.80, 1.35)1.04 (0.72, 1.52)
    APM vs Non-APM comparison relative rate0.81 (0.53, 1.23)1.28 (0.71, 2.29)
Alternative encounters
    APM clinics801.53872.66950.091.09 (1.04, 1.14)1.09 (0.99, 1.19)
    Non-APM comparison clinics657.28723.15769.751.10 (1.04, 1.17)1.06 (0.98, 1.16)
    APM vs Non-APM comparison relative rate0.99 (0.92, 1.07)1.02 (0.90, 1.16)
  • ACA, Affordable Care Act; APM, alternative payment methodology.

  • Total alternative encounters included hospice visits, home health visits, nurse visits, telemedicine, telephone and email consultations, lab- and imaging-only visits, and visits with a pharmacist.

  • * Rates were determined from Poisson regression models of APM status × month, utilizing a robust sandwich estimator to account for correlations within clinics and were adjusted for percent Hispanic, percent Medicaid insurance and percent of panel in a high needs age group.

  • There was a positive trend in outcome within the pre-period in both APM and Comparison groups; differences in pre-period trend were not statistically significant.

  • There were no statistically significant trends in outcomes during the pre-period.