Evaluating the Patient-Centered Medical Home: Potential and Limitations of Claims-Based Data
This State Health Policy Briefing summarizes the advantages and disadvantages of using claims-based data to evaluate patient-centered medical home initiatives. A Medicaid-based medical home initiative in Oklahoma and a multi-payer medical home pilot in Rhode Island are highlighted. Both states are using a mixture of claims-based data and supplementary resources like patient or provider surveys and data collected from electronic medical records to evaluate their medical home programs. Understanding the potential uses and limitations of both claims data and other data sources that can aid evaluators will help states to design appropriate evaluative criteria for their medical home programs.