Table, Supplemental Digital Content 1: Specifications of Quality-of-Care, Utilization and Cost MeasuresGenerated from Administrative Data, and Summary of Estimated Impact of Intervention
LABEL / MEASURE / DEFINITION / SUMMARY OF OUTCOMESNumerator / Denominator / Estimated Impact of MMPP:
Medicaid Population
Increase in Measure (INC),
Decrease in Measure (DEC),
or No Change (NC) / Estimated Impact of MMPP:
Private Insurance Population
Increase in Measure (INC),
Decrease in Measure (DEC),
or No Change (NC)
2011 / 2012 / 2013 / 2011 / 2012 / 2013
QUALITY-OF-CARE MEASURES
Q01 / Breast cancer screening / Number of women aged 40-64 years with one or more mammograms / Number of women aged
40-64 years / INC
ROR: 1.13
[1.01-1.26] / DEC†
ROR: 0.72
[0.62-0.85] / DEC†
ROR: 0.78
[0.68-0.90] / DEC
ROR: 0.97
[0.92-1.02] / DEC
ROR: 0.95
[0.89-1.02] / DEC
ROR: 0.92
[0.84-1.00]
Q02 / Cervical cancer screening / Number of women aged 21–64 years with one or more Papanicolaousmear tests / Number of women aged
21–64 years / DEC
ROR: 0.91
[0.80-1.03] / DEC†
ROR: 0.67
[0.57-0.80] / DEC†
ROR: 0.76
[0.65-0.88] / INC
ROR: 1.04
[1.00-1.09] / INC*
ROR: 1.08
[1.03-1.13] / INC*
ROR: 1.08
[1.02-1.16]
Q03 / Postpartum care visit following live birth / Number of women with postpartum visit between 21–56 days after live delivery / Number of women who had a live birth / DEC
ROR: 0.88
[0.68-1.15] / DEC
ROR: 0.40
[0.13-1.21] / DEC
ROR: 0.82
[0.42-1.61] / DEC
ROR: 0.80
[0.54-1.18] / DEC
ROR: 0.67
[0.35-1.28] / DEC†
ROR: 0.37
[0.21-0.63]
Q04 / Prescription of long-term drug therapy for asthma / Number of individuals aged 5-40 years with a diagnosis of mild, moderate, or severe persistent asthma and prescribed either the preferred long‐term control medication (inhaled corticosteroid) or an acceptable alternative treatment / Number of individuals aged 5-40 years with a diagnosis of mild, moderate, or severe persistent asthma / DEC†
ROR: 0.81
[0.74-0.89] / DEC†
ROR: 0.56
[0.41-0.76] / DEC†
ROR: 0.60
[0.50-0.71] / NA / NA / NA
Q05 / Persistence with ACE inhibitor or ARB therapy for diabetes / Number of individuals aged 18 years and older with a diagnosis of diabetes and persistent with ACE inhibitor or ARB therapy / Number of individuals aged 18 years and older with a diagnosis of diabetes / INC
ROR: 1.12
[0.94-1.33] / DEC
ROR: 0.95
[0.82-1.11] / DEC†
ROR: 0.73
[0.61-0.86] / NA / NA / NA
Q06 / Well-care visits for children / Number of children 3–6 years old with one or more well–child visits to any PCP / Number of children aged
3-6 years / DEC
Δ: -0.02
[SE: 0.02] / NA / DEC*
Δ: -0.05
[SE: 0.02] / NC
Δ: 0.00
[SE: 0.02] / INC
Δ: 0.02
[SE: 0.03] / INC
Δ: 0.01
[SE: 0.02]
Q07 / Well-care visits foradolescents and young adults / Number of individuals aged 12–21 years with one or more PCP or OB/GYN visits / Number of individuals aged 12–21 years / DEC
Δ: -0.03
[SE: 0.02] / DEC†
Δ: -0.08
[SE: 0.03] / DEC†
Δ: -0.09
[SE: 0.03] / INC*
Δ: 0.03
[SE: 0.01] / INC
Δ: 0.02
[SE: 0.01] / INC*
Δ: 0.05
[SE: 0.02]
Q08 / Asthma admissions (<40 years) / Number of individuals less than 40 years of age diagnosed with asthma and recording one or more asthma-related inpatient admissions / Number of individuals diagnosed with asthma and younger than 40 years of age / INC
ROR: 1.28
[0.95-1.73] / DEC
ROR: 0.78
[0.53-1.14] / DEC*
ROR: 0.49
[0.30-0.82] / NA / NA / NA
Q09 / Asthma admissions (≥40 years) / Number of individuals 40 years or older diagnosed with asthma or COPD and recording one or more diagnosis-related inpatient admissions / Number of individuals 40 years or older and diagnosed with asthma or COPD / INC
ROR: 1.74
[0.84-3.62] / INC
ROR: 1.28
[0.63-2.56] / INC
ROR: 1.01
[0.73-1.40] / NA / NA / NA
Q10 / Hypertension admissions / Number of individuals diagnosed with hypertension and recording one or more hypertension-related admissions / Number of individuals diagnosed with hypertension / INC*
ROR: 1.75
[1.14-2.69] / NA / NA / NA / NA / NA
Q11 / CHF admissions / Number of adults with one or more CHF-related inpatient admissions / Number of adults diagnosed with
CHF / DEC
ROR: 0.77
[0.48-1.22] / DEC
ROR: 0.91
[0.53-1.56] / DEC
ROR: 0.74
[0.35-1.59] / INC
ROR: 1.21
[0.40-3.68] / NA / NA
Q12 / Admissions for diabetes complication / Number of adults with one or more hospitalizations for short-term complications of diabetes / Number of adults diagnosed with diabetes / INC*
ROR: 4.19
[1.53-11.48] / INC†
ROR: 10.39
[5.71-18.92] / INC†
ROR: 6.28
[3.18-12.38] / NA / NA / NA
Q13 / HbA1c management test for diabetes in adults / Number of individuals aged 18-64 years old diagnosed with diabetes and receiving one or more HbA1c test(s) / Number of non-elderly adults diagnosed with diabetes / NA / DEC
ROR: 0.61
[0.36-1.02] / DEC
ROR: 0.83
[0.40-1.73] / DEC
ROR: 0.96
[0.85-1.09] / INC†
ROR: 1.41
[1.23-1.62] / INC
ROR: 1.21
[1.02-1.44]
Q14 / HbA1c management test for diabetes in children / Number of individuals aged 0-17 years old diagnosed with diabetes and receiving one or more HbA1c test(s) / Number of pediatric individuals diagnosed with diabetes / INC
ROR: 2.33
[1.05-5.20] / INC
ROR: 1.84
[0.92-3.70] / DEC
ROR: 0.87
[0.39-1.93] / INC
ROR: 1.92
[0.97-3.79] / NA / INC
ROR: 1.52
[0.52-4.43]
Q15 / Prescription for ACE inhibitor or ARB therapy for LVSD or HF / Number of adults diagnosed with LVSD or HF and prescribed ACE inhibitor or ARB therapy / Number of adults diagnosed with LVSD or HF / DEC*
ROR: 0.57
[0.37-0.87] / DEC
ROR: 0.57
[0.30-1.07] / DEC
ROR: 0.86
[0.29-2.48] / NA / NA / NA
Q16 / Persistence on ACE inhibitor or ARB therapy for LVSD or HF / Number of adults diagnosed with LVSD or HF and persistent with prescribed ACE inhibitor or ARB therapy / Number of adults diagnosed with LVSD or HF / INC
ROR: 1.12
[0.85-1.47] / DEC
ROR: 0.89
[0.64-1.24] / DEC
ROR: 0.77
[0.39-1.50] / NA / NA / NA
HEALTH SERVICES UTILIZATION MEASURES
U01 / Proportion with ED visit / Number of patients with one or more
ED visits / Total number of patients / INC
ROR: 1.04
[0.94-1.13] / DEC
ROR: 0.92
[0.85-1.00] / DEC
ROR: 0.91
[0.84-0.99] / DEC
ROR: 0.99
[0.96-1.03] / INC
ROR: 1.07
[1.00-1.15] / INC
ROR: 1.03
[0.94-1.13]
U02 / Proportion of asthma, CHF, or diabetes patients with ED visit / Number of patients diagnosed with asthma, CHF, or diabetes and recording a diagnosis-related ED visit / Number of patients diagnosed with any of these conditions / DEC*
ROR: 0.89
[0.82-0.96] / DEC
ROR: 0.86
[0.72-1.04] / DEC*
ROR: 0.81
[0.70-0.94] / INC
ROR: 1.17
[0.90-1.50] / DEC
ROR: 0.98
[0.70-1.35] / INC*
ROR: 1.51
[1.09-2.10]
U03 / Proportion with inpatient stay / Number of patients with one or more inpatient hospitalizations / Total number of patients / INC*
ROR: 1.15
[1.03-1.30] / INC†
ROR: 1.37
[1.17-1.61] / INC†
ROR: 1.34
[1.17-1.55] / INC
ROR: 1.02
[0.93-1.11] / DEC
ROR: 0.98
[0.93-1.04] / DEC
ROR: 0.97
[0.90-1.05]
U04 / Proportion of asthma, CHF, or diabetes patients with inpatient stay / Number of patients diagnosed with asthma, CHF, or diabetes and recording a diagnosis- related inpatient visit / Number of patients diagnosed with any of these conditions / INC
ROR: 1.03
[0.93-1.15] / INC
ROR: 1.02
[0.84-1.24] / DEC*
ROR: 0.68
[0.52-0.88] / INC
ROR: 1.02
[0.73-1.43] / DEC
ROR: 0.82
[0.62-1.09] / DEC
ROR: 0.95
[0.67-1.35]
U05 / Total inpatient days among hospitalized patients / Total number of calendar days spent on inpatient admission among patients with at least one hospitalization / Number of patients with at least one hospitalization / INC
Δ: 0.34
[SE: 0.30] / INC*
Δ: 0.92
[SE: 0.40] / INC
Δ: 0.24
[SE: 0.37] / INC
Δ: 0.24
[SE: 0.28] / DEC
Δ: -0.03
[SE: 0.29] / INC*
Δ: 0.71
[SE: 0.29]
U06 / 30-day readmission following hospitalization / Number of patients with at least one readmission within 30 days of discharge from hospitalization (excluding transfers) / Number of patients with at least one admission / DEC
ROR: 0.93
[0.78-1.11] / INC†
ROR: 1.51
[1.22-1.86] / INC†
ROR: 1.51
[1.17-1.95] / INC
ROR: 1.12
[0.79-1.58] / DEC
ROR: 0.96
[0.71-1.31] / INC
ROR: 1.30
[1.01-1.68]
U07 / Total nursing home days among patients with nursing home stays / Total number of calendar days spent in nursing home among patients with a nursing home stay / Number of patients with at least one nursing home stay / INC
Δ: 5.78
[SE: 7.82] / INC†
Δ: 32.39
[SE: 10.72] / INC*
Δ: 23.36
[SE: 11.27] / INC
Δ: 0.64
[SE: 3.91] / INC
Δ: 1.34
[SE: 4.29] / NC
Δ: 0.00
[SE: 5.10]
U08 / Mean ED visits / Total number of ED visits among patients with an ED visit / Number of patients with ≥1 ED visit / INC
Δ: 0.03
[SE: 0.03] / INC
Δ: 0.09
[SE: 0.05] / INC
Δ: 0.09
[SE: 0.06] / INC
Δ: 0.01
[SE: 0.01] / INC
Δ: 0.03
[SE: 0.02] / INC
Δ: 0.01
[SE: 0.03]
U09 / CHF readmission rate / Number of patients recording CHF-related inpatient stays and readmitted due to CHF within 30 days of initial discharge / Number of patients recording CHF-related inpatient stays / NA / NA / NA / NA / NA / NA
U10 / Mean home health care visits / Total number of home health care visits by among patients / Total number of patients receiving home health care / DEC
Δ: -4.46
[SE: 5.91] / DEC
Δ: -20.88
[SE: 28.81] / DEC†
Δ: -40.92
[SE: 11.00] / INC
Δ: 0.33
[SE: 0.43] / DEC
Δ: -0.05
[SE: 0.61] / INC
Δ: 0.75
[SE: 0.65]
U11 / Proportion with office visit / Number of patients with one or more PCP office visits / Total number of patients / DEC
ROR: 0.89
[0.75-1.06] / DEC*
ROR: 0.56
[0.38-0.83] / DEC
ROR: 0.69
[0.42-1.13] / INC†
ROR: 1.75
[1.44-2.12] / INC*
ROR: 1.41
[1.13-1.76] / INC
ROR: 1.03
[0.71-1.49]
U12 / Mean office visits / Total number of PCP visits by patients / Number of patients with at least one PCP visit / INC
Δ: 0.05
[SE: 0.13] / DEC
Δ: -0.15
[SE: 0.22] / DEC
Δ: -0.14
[SE: 0.22] / NC
Δ: 0.00
[SE: 0.04] / INC
Δ: 0.08
[SE: 0.04] / INC
Δ: 0.04
[SE: 0.06]
U13 / Totalhospice days / Total number of calendar days spent in hospice among patients with a hospice stay / Number of patients with at least one hospice stay / NA / NA / NA / INC
Δ: 15.46
[SE: 33.46] / INC
Δ: 11.88
[SE: 41.13] / NA
U14 / Mean prescriptions / Total number of pharmaceutical prescriptions filled by patients / Number of patients with at least one prescription / DEC*
Δ: -0.39
[SE: 0.18] / DEC
Δ: -0.30
[SE: 0.29] / DEC
Δ: -0.32
[SE: 0.27] / NA / NA / NA
U15 / Proportion of asthmapatients with ED visit / Number of patients diagnosed with asthma and recording a diagnosis-related ED visit / Number of patients diagnosed with asthma / DEC*
ROR: 0.90
[0.83-0.97] / DEC
ROR: 0.85
[0.70-1.02] / DEC†
ROR: 0.77
[0.67-0.88] / INC
ROR: 1.19
[0.92-1.53] / INC
ROR: 1.02
[0.72-1.46] / INC*
ROR: 1.55
[1.12-2.14]
U16 / Proportion of CHFpatients with ED visit / Number of patients diagnosed with CHF and recording a diagnosis-related ED visit / Number of patients diagnosed with CHF / DEC
ROR: 0.83
[0.49-1.40] / INC
ROR: 1.10
[0.43-2.81] / INC
ROR: 2.66
[0.78-9.07] / INC
ROR: 1.57
[0.34-7.36] / DEC
ROR: 0.87
[0.18-4.24] / INC
ROR: 2.20
[0.84-5.71]
U17 / Proportion of diabeticpatients with ED visit / Number of patients diagnosed with diabetes and recording a diagnosis-related ED visit / Number of patients diagnosed with diabetes / DEC
ROR: 0.52
[0.14-1.94] / INC
ROR: 1.09
[0.53-2.25] / INC
ROR: 2.47
[0.53-11.60] / NA / DEC
ROR: 0.19
[0.03-1.10] / DEC
ROR: 0.38
[0.07-2.01]
U18 / Proportion of asthmapatients with inpatient visit / Number of patients diagnosed with asthma and recording a diagnosis-related inpatient visit / Number of patients diagnosed with asthma / INC
ROR: 1.14
[0.95-1.37] / DEC
ROR: 0.93
[0.75-1.15] / DEC*
ROR: 0.56
[0.36-0.87] / NC
ROR: 1.00
[0.63-1.59] / DEC
ROR: 0.75
[0.47-1.20] / INC
ROR: 1.02
[0.54-1.92]
U19 / Proportion of CHFpatients with inpatient visit / Number of patients diagnosed with CHF and recording a diagnosis-related inpatient visit / Number of patients diagnosed with CHF / DEC
ROR: 0.58
[0.34-0.99] / DEC
ROR: 0.68
[0.37-1.24] / DEC
ROR: 0.87
[0.59-1.29] / INC
ROR: 1.07
[0.52-2.19] / DEC
ROR: 0.75
[0.38-1.49] / DEC
ROR: 0.75
[0.33-1.70]
U20 / Proportion of diabeticpatients with inpatient visit / Number of patients diagnosed with diabetes and recording a diagnosis-related inpatient visit / Number of patients diagnosed with diabetes / INC
ROR: 1.91
[0.84-4.32] / INC†
ROR: 2.76
[1.69-4.53] / INC
ROR: 1.75
[0.80-3.85] / DEC
ROR: 0.51
[0.18-1.42] / DEC
ROR: 0.74
[0.36-1.53] / INC
ROR: 1.01
[0.36-2.83]
HEALTH EXPENDITURE / COST MEASURES
C01 / Mean inpatient expenditure for hospitalized patients / Total inpatient payments among patients / Number of patients with inpatient payments / DEC*
Δ: -$6,242
[SE: $2,577] / DEC*
Δ: -$5,873
[SE: $2,315] / DEC*
Δ: -$6,447
[SE: $2,423] / INC
Δ: $6
[SE: $1,061] / DEC
Δ: -$525
[SE: $973] / INC
Δ: $1,040
[SE: $931]
C02 / Mean outpatient expenditure among patients with outpatient utilization / Total outpatient payments among patients / Number of patients with outpatient payments / DEC†
Δ: -$701
[SE: $263] / DEC†
Δ: -$789
[SE: $271] / DEC*
Δ: -$737
[SE: $273] / DEC*
Δ: -$146
[SE: $68] / DEC
Δ: -$41
[SE: $80] / INC
Δ: $33
[SE: $105]
C03 / Mean total payments / Total payments among patients / Total number of patients / DEC*
Δ: -$791
[SE: $369] / DEC
Δ: -$316
[SE: $695] / DEC
Δ: -$700
[SE: $865] / DEC
Δ: -$110
[SE: $77] / DEC
Δ: -$74
[SE: $81] / DEC
Δ: -$9
[SE: $91]
C04 / Mean ED payments among patients with ED visit / Total ED payments among patients / Number of patients with ED visit / DEC
Δ: -$5
[SE: $4] / INC
Δ: $26
[SE: $24] / INC
Δ: $29
[SE: $25] / DEC
Δ: -$11
[SE: $7] / DEC
Δ: -$2
[SE: $9] / INC
Δ: $9
[SE: $11]
C05 / Mean home health payments among patients witha home health visit / Total home health payments among patients / Number of patients with home health payments / INC
Δ: $33
[SE: $1,250] / DEC
Δ: -$9,074
[SE: $8,974] / DEC
Δ: -$1,751
[SE: $2,577] / INC
Δ: $72
[SE: $152] / INC
Δ: $129
[SE: $144] / INC
Δ: $359
[SE: $200]
C06 / Mean nursing home payments among patients with a nursing home stay / Total skilled nursing facility payments among patients / Number of patients with skilled nursing payments / DEC
Δ: -$1,355
[SE: $3,252] / INC*
Δ: $9,505
[SE: $4,621] / INC
Δ: $3,509
[SE: $4,451] / INC
Δ: $679
[SE: $1,797] / DEC
Δ: -$1,081
[SE: $1,797] / INC
Δ: $383
[SE: $2,013]
C07 / Mean hospice payments among patients with hospice care / Total hospice expenditure among patients / Number of patients receiving hospice care / NA / NA / NA / INC
Δ: $3,014
[SE: $5,425] / INC
Δ: $4,425
[SE: $5,845] / INC
Δ: $3,011
[SE: $2,139]
C08 / Mean radiology payments among patients with radiology encounters / Total radiology expenditure among patients / Number of patients receiving radiology services / INC
Δ: $15
[SE: $9] / INC
Δ: $65
[SE: $58] / INC
Δ: $58
[SE: $41] / DEC
Δ: -$13
[SE: $18] / INC
Δ: $21
[SE: $19] / INC
Δ: $9
[SE: $20]
C09 / Mean laboratory payments among patients with laboratory service / Total laboratory services expenditure among patients / Number of patients receiving laboratory services / INC
Δ: $11
[SE: $10] / INC
Δ: $207
[SE: $311] / INC
Δ: $105
[SE: $189] / DEC
Δ: -$14
[SE: $10] / DEC
Δ: -$22
[SE: $13] / DEC
Δ: -$13
[SE: $13]
C10 / Mean prescription costs among patients with a prescription fill / Total pharmaceutical payments among patients / Number of patients with at least one prescription fill / INC
Δ: $216
[SE: $394] / INC
Δ: $360
[SE: $414] / INC
Δ: $311
[SE: $436] / NA / NA / NA
C11 / Mean payments for other services / Total expenditure among patients for services not covered in categories above / Total number of patients / DEC†
Δ: -$353
[SE: $88] / INC
Δ: $70
[SE: $165] / INC
Δ: $119
[SE: $193] / DEC*
Δ: -$56
[SE: $24] / DEC
Δ: -$5
[SE: $26] / DEC
Δ: -$33
[SE: $28]
C12 / Mean expenditure on office visits to attributed practice / Total payments for all office visits by patients to their attributed practice / Total number of patients / DEC
Δ: -$20
[SE: $25] / INC
Δ: $12
[SE: $111] / NA / DEC
Δ: -$8
[SE: $5] / DEC
Δ: -$10
[SE: $9] / DEC
Δ: -$19
[SE: $11]
C13 / Mean expenditure on office visits to non-attributed practice / Total payments for all office visits by patients to practices to which they were not attributed / Total number of patients / DEC
Δ: -$14
[SE: $13] / DEC
Δ: $-211
[SE: $443] / DEC
Δ: -$547
[SE: $787] / DEC
Δ: -$5
[SE: $11] / DEC
Δ: -$6
[SE: $15] / INC
Δ: $7
[SE: $18]
Notes: Quality-of-care, utilization and cost measures were evaluated at the practice level among attributed patients meeting numerator/denominator criteria during each measurement year. The computed measures were subsequently aggregated at the payor level to obtain the summary estimates above. Results presented are marginal estimates from difference-in-differencesmodels and are adjusted for practice location (proximity to large/small metropolitan area), practice type (solo vs. other), practice use of electronic medical records, proportion of white practitioners in the practice and patient case-mix. For binary measures aggregated to practice-level proportions, we present the ratio of odds ratios (ROR) and 95% confidence interval (CI).For continuous measures aggregated to practice-level means, we present the average difference-in-differences estimate (Δ) and standard error (SE).P values for these statistics are statistically significant at the 5% (*) and 1% (†) levels.
INCindicates a statistically significant positive increase in the measure as compared to the baseline year (2010). DECindicates a statistically significant decrease in the measure as compared to the baseline year. NCsignifies no statistically significant difference in the outcome in the given yearas compared to the baseline year. NA indicates that results are not reported due to one or more of the following: number of patients eligible was either zero or too small; the statistical model failed to converge; prescription drug measures were not available for commercially insured beneficiaries.
ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; AMI = acute myocardial infarction; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; ED = emergency department; HF = heart failure; LVSD = left ventricular systolic dysfunction; MMPP – Maryland Multi-Payor Patient-Centered Medical Home Program; OB/GYN = obstetrician/gynecologist; PCP = primary care physician