Medical homes and cost and utilization among high-risk patients.

OBJECTIVES: Evaluate the effects of the patient-centered medical home (PCMH) model on medical costs and utilization in the nonpediatric population, particularly among high-risk patients. STUDY DESIGN: Longitudinal case-control design, comparing per member per month (PMPM) cost and utilization per 1000 patients for members enrolled in PCMH and non-PCMH practices from 2009 to 2011. METHODS: Commercial health maintenance organization members in nonpediatric practices that adopted the PCMH model in 2009 were matched to patients in nonpediatric practices that did not adopt the model until 2011 or later. Propensity score matching was used to identify a pool of similar controls, and difference-in-differences regression analysis was used to compare PCMH and non-PCMH patients relative to baseline. Analysis was conducted using the complete pool of matched patients (N = 6940 cases and 6940 controls), then using the 10% of patients with the highest DxCG risk scores (N = 654 cases and 734 controls). RESULTS: There were no significant cost or utilization differences for the overall population. Total cost decreased significantly more for the PCMH group than for controls in the high-risk group in years 1 and 2 (reductions of $107 and $75 PMPM), driven by lower inpatient costs. The PCMH group experienced a significantly greater reduction in inpatient admissions in all 3 years (61, 48, and 94 hospitalizations per 1000). CONCLUSIONS: PCMH practices had significantly reduced costs and utilization for the highest risk patients, particularly with respect to inpatient care. As high-risk members represent a high-cost group, the most benefit can be gained by targeting these members.

Semantic fields in low-functioning autism.

Restricted semantic fields and resultant stimulus overselectivity are often thought to be typical of low-functioning autism, as is a strong visual processing preference. However, these conclusions may in part be an artifact of testing methodology. A 12-year-old, low-functioning and nonverbal autistic boy was tested on an auditory word-to-picture selection task. The picture foils were chosen to have visual features, semantic features, both, or neither in common with the correct answer. Errors were made more often to semantically than to visually related items, and he showed generalization to items that had not been explicitly trained. This is taken as evidence that his semantic fields are broader than otherwise apparent, and that he was capable of expanding his semantic representations independently of specific training.