Many large multi-specialty groups have been working on better primary care and care coordination for decades. Many of the medical home features came from the work of these groups. It was not surprising then, that most of them have participated in various medical home, accountable care and other primary care and care coordination initiatives. One of these prestigious multi-specialty groups is the Geisinger Health System in Pennsylvania, which calls its medical home program the ProvenHealth Navigator and uses the concept for both Medicare beneficiaries and the adult commercially insured population. A study in Health Affairs examines results from the program. (HA Article) The Geisinger program consists of five elements: patient-centered primary care; population management for high-risk patients or those with specific disease management needs; enhanced care coordination in a “medical neighborhood” of all providers treating a patient; performance management which uses quality and patient satisfaction measures; and value-based reimbursement models.
The study looked at cost data from 2006 to 2013 for members of Medicare Advantage plans who had to select a primary care physician. Spending was broken into the usual categories and was equivalent to reimbursement, not the actual cost of delivering care. A very large number of member months was included in the study data. On a fully adjusted per member per month basis, being cared for in the ProvenHealth Navigator system seemed to save an average of $53 or about $600 a year. The largest source of this saving was inpatient care, which accounted for around two-thirds. Savings in the other cost categories of drugs, hospital outpatient and physician visits, were modest and not statistically significant. The longer a primary care site participated in the program, the greater its savings seemed to be. There also was no data about the cost of the program, which likely was substantial. So it appears consistent with the notion that an intensive primary care program can reduce spending, but what the financial impact on the providers participating in the program might be is not clear.