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Comment & Response
July 23/30, 2014

Evaluating a Multipayer Medical Home Intervention—Reply

Author Affiliations
  • 1RAND Corporation, Boston, Massachusetts
  • 2Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
JAMA. 2014;312(4):436. doi:10.1001/jama.2014.7146

In Reply Drs Valko and Wender suggest that a 3-year time horizon may be too short to observe changes in health care costs and utilization, reporting that in their medical home practice these changes occurred later. It is certainly possible that reducing costs and excess health care utilization may require sustained changes and longer observation periods. Continued evaluations are needed.

Registry data are attractive sources of performance measurement, but they were not reported by the comparison practices. Despite the inaccuracies that can affect health plan claims and laboratory data, these data had the advantage of being collected using similar methods in both pilot and comparison practices in our study. This methodological consistency enabled us to attribute observed changes in performance to participation in a medical home intervention rather than to modifications to data reporting that occurred only among the pilot practices. In addition, we took steps to mitigate for the possibility of data inaccuracies reported by Valko and Wender by controlling for health plan enrollment in health maintenance organization products.