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 (550.57, 769.79) | 672.82 (544.77, 830.98) | 716.07 (565.29, 907.07) | 1.03 (0.98, 1.09) | 1.06 (0.98, 1.15) |
| Non-APM comparison clinics | 435.10 (371.15, 510.07) | 463.21 (409.76, 523.62) | 480.33 (427.15, 540.12) | 1.07 (0.99, 1.13) | 1.04 (0.96, 1.12) |
| APM vs non-APM comparison relative rate | 1.50 (1.17, 1.92) | 1.45 (1.11, 1.90) | 1.49 (1.12, 1.99) | 0.97 (0.89, 1.05) | 1.03 (0.92, 1.15) |
| New patient visits‡ | |||||
| APM clinics | 6.52 (4.68, 9.10) | 5.47 (3.94, 7.60) | 7.30 (5.75, 9.27) | 0.84 (0.60, 1.16) | 1.34 (0.86, 2.08) |
| Non-APM comparison clinics | 4.94 (3.84, 6.36) | 5.12 (3.55, 7.40) | 5.35 (3.71, 7.72) | 1.04 (0.80, 1.35) | 1.04 (0.72, 1.52) |
| APM vs non-APM comparison relative rate | 1.32 (0.87, 2.01) | 1.07 (0.64, 1.77) | 1.36 (0.88, 2.11) | 0.81 (0.53, 1.23) | 1.28 (0.71, 2.29) |
| Alternative encounters‡ | |||||
| APM clinics | 801.53 (707.54, 908.01) | 872.66 (748.41, 1017.53) | 950.09 (779.62,1157.82) | 1.09 (1.04, 1.14) | 1.09 (0.99, 1.19) |
| Non-APM comparison clinics | 657.28 (585.48, 737.88) | 723.15 (642.99, 813.30) | 769.75 (662.70, 894.10) | 1.10 (1.04, 1.17) | 1.06 (0.98, 1.16) |
| APM vs Non-APM comparison relative rate | 1.22 (1.02, 1.46) | 1.21 (0.98, 1.48) | 1.23 (0.96, 1.59) | 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.