Impact of a Statewide Multi-Payer Patient-Centered Medical Home Program on Antihypertensive Medication Adherence Oludolapo A. Fakeye, PhD, MA, 1 Niharika Khanna, MD, MBBS, DGO, 2 Yea-Jen Hsu, PhD, MHA, 1 and Jill A. Marsteller, PhD, MPP 1 Abstract Evidence suggests that the patient-centered medical home (PCMH) model of primary care improves manage- ment of chronic disease, but there is limited research contrasting this model’s effect when financed by a single payer versus multiple payers, and among patients with different types of health insurance. This study evaluates the impact of a statewide medical home demonstration, the Maryland Multi-Payer PCMH Program (MMPP), on adherence to antihypertensive medication therapy relative to non-PCMH primary care and to the PCMH model when financed by a single payer. The authors used a difference-in-differences analytic design to analyze changes in medication possession ratio for antihypertensive medications among Medicaid-insured and privately insured non-elderly adult patients attributed to primary care practices in the MMPP (‘‘multi-payer PCMHs’’), medical homes in Maryland that participated in a regional PCMH program funded by a single private payer (‘‘single- payer PCMHs’’), and non-PCMH practices in Maryland. Comparison sites were matched to multi-payer PCMHs using propensity scores based on practice characteristics, location, and aggregated provider characteristics. Multi-payer PCMHs performed better on antihypertensive medication adherence for both Medicaid-insured and privately insured patients relative to single-payer PCMHs. Statistically significant effects were not observed consistently until the second year of the demonstration. There were negligible differences in outcome trends between multi-payer medical homes and matched non-PCMH practices. Findings indicate that health care delivery innovations may yield superior population health outcomes under multi-payer financing compared to when such initiatives are financed by a single payer. Keywords: medication adherence, patient-centered medical home, hypertension, multi-payer Introduction M ortality rates from cardiovascular disease have decreased in high-income countries, including the United States. 1,2 This decline has been attributed in part to effective medication therapies for patients with hyperten- sion. 3 Adherence to antihypertensive medication therapy is fundamental to reducing the risk of worsening cardiovascu- lar symptoms, organ damage, and stroke in hypertensive patients. 4 Improving adherence to blood pressure control medications is an important strategy of the US Department of Health and Human Services’ Million Hearts 2022 initiative to reduce the incidence of heart attacks and strokes. 5 The patient-centered medical home (PCMH)—or medical home for short—is an innovative model of primary care with strong potential to enhance management of hypertension and other chronic conditions. The model originated in pediatrics and is centered on continuity and coordination of the patient’s care by an identifiable primary care physician and his/her care team. 6 The patient maintains a direct, longstanding relation- ship with this personal provider, who takes accountability for the care provided to the patient and organizes appropriate care for them across the spectrum of health care settings as needed. Relative to traditional or routine primary care, the PCMH model is centered on safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity of health services provided. 7,8 The model also promotes better health for populations through emphasis on patient education, delivery of evidence-based preventive services, and care management for complex patients. 7 1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 2 Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA. Prior Presentation: A summary of the study and overall findings were presented at the 2018 AcademyHealth Annual Research Meeting held June 24–26, 2018 in Seattle, WA. POPULATION HEALTH MANAGEMENT Volume 25, Number 3, 2022 ª Mary Ann Liebert, Inc. DOI: 10.1089/pop.2021.0172 309 Downloaded by 50.19.178.202 from www.liebertpub.com at 04/25/23. For personal use only.