A lot of approaches have been tried to improve primary care and care coordination. Rigorous research tends to show minimal effects from most of these. A study published in the Journal of the American Medical Association analyzes the effects of an integrated, team-based primary care approach at a large Utah-based health system. (JAMA Article) Patients in the integrated approach were compared with those under traditional primary care. The study analyses used data on adult patients from 2010 to 2013, although the patients included had to be treated for a longer period of time in the clinics. The intervention involved a firm integration of behavioral and physical health care. Care teams were organized around physicians and involved operational training and communication within the teams, as well as technology support. The signature feature of the intervention, however, was the focus on fully integrating mental health treatment into the primary care environment. As is usually the case, the analyses were adjusted for various socio-demographic and socio-economic factors. Outcomes included relatively standard quality measures, utilization of various type of services and costs, measured by actual payments for services. The cost of the program was also calculated, so that a return on that cost could be estimated.
Performance on quality measures was better in the integrated care model, including screening for depression, receipt of diabetes care, control of high blood pressure and documentation of self-care plans. In regard to utilization outcomes, patients in the integrated model had 18 ER visits per 100 person years versus 23.5 for the traditional practice patients; 9.5 hospitalizations per 100 person years versus 10.6, 3.3 ambulatory care sensitive admissions per 100 person years versus 4.3, and 233 primary care visits per 100 person years versus 250. There were no significant differences between the two groups in regard to urgent care use or visits to specialty physicians. There were no significant differences in cost for Medicare patients, but costs were lower for the integrated team-based patients with commercial insurance, although the difference was modest. The program was estimated to cost the health system about $10 annually per patient, which seems exceptionally low, and which was lower that the cost reductions related to health care use. So the program appears to have generated a net savings to the health care system. This intervention seems to show the value of integrating mental health treatment more fully into primary care.