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)
| Outcome | Encounters/1000 Patients per Month* | Relative Rates | |||
|---|---|---|---|---|---|
| Pre-APM | Post-APM | Post-ACA | Post-APM vs Pre-APM | Post-ACA vs Post-APM | |
| Total encounters† | |||||
| APM clinics | 651.02 | 672.82 | 716.07 | 1.03 (0.98, 1.09) | 1.06 (0.98, 1.15) |
| Non-APM comparison clinics | 435.10 | 463.21 | 480.33 | 1.07 (0.99, 1.13) | 1.04 (0.96, 1.12) |
| APM vs Non-APM comparison relative rate | 0.97 (0.89, 1.05) | 1.03 (0.92, 1.15) | |||
| New patient visits‡ | |||||
| APM clinics | 6.52 | 5.47 | 7.30 | 0.84 (0.60, 1.16) | 1.34 (0.86, 2.08) |
| Non-APM comparison clinics | 4.94 | 5.12 | 5.35 | 1.04 (0.80, 1.35) | 1.04 (0.72, 1.52) |
| APM vs Non-APM comparison relative rate | 0.81 (0.53, 1.23) | 1.28 (0.71, 2.29) | |||
| Alternative encounters‡ | |||||
| APM clinics | 801.53 | 872.66 | 950.09 | 1.09 (1.04, 1.14) | 1.09 (0.99, 1.19) |
| Non-APM comparison clinics | 657.28 | 723.15 | 769.75 | 1.10 (1.04, 1.17) | 1.06 (0.98, 1.16) |
| APM vs Non-APM comparison relative rate | 0.99 (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.