Heterogeneous Treatment Effects of the Patient Aligned Care Team Initiative on Service Utilization in the Veterans Health Administration

Abstract

Payers across the nation have been testing new models of care delivery like the patient-centered medical home (PCMH) to improve quality of care and reduce costs. PCMHs use team-based, patient-centered care to reduce costs by shifting utilization from high-cost services like emergency departments and hospitals to primary care settings. Literature on the effectiveness of PCMHs is mixed but fails to account for treatment effect heterogeneity. Applying unique clinical and methodological innovations, we estimated heterogenous treatment effects among one of the nation’s largest PCMH initiatives, the Veterans Health Administration’s Patient Aligned Care Team (PACT) initiative. We found little evidence of heterogeneous treatment effects by patient characteristics such as risk status, demographics, and social stability and clinic-level measures of access up to six years into PACT. Continuing to expand this knowledge base is critical to better target interventions, particularly in resource-constrained environments.