The Outcomes of Dedicated, At-risk Primary Care Groups

Medicare Advantage continues to grow rapidly and health plans are increasingly working with primary clinics focused on servicing the Medicare population and putting those providers at significant financial risk for the cost of their patients.  One of the few pieces of research on the outcomes of these primary care clinics was published recently in the American Journal of Managed Care.   (AJMC Article)   This was a retrospective study analyzing the utilization patterns of patients in a “high-touch” model of primary care (ChenMed) which encouraged frequent visits or encounters of the patients with clinicians compared to patients in a more usual care setting, but also a Medicare-focused practice.  The patients in the two settings were matched on a demographic and health status basis.  About 5700 patients were in each group.  Physicians in the high-touch model had smaller patient panels, which accommodated the greater frequency of encounters.  The average number of primary care visits per year per patient for the high-touch model was 8.7 versus 3.8 in the other practice setting.  A much higher percent of patients in the high-touch model also had appropriate preventive medications, particularly for chronic diseases like diabetes, high blood pressure and coronary artery disease.  There were about half as many hospital admissions for the high-touch model.  The result was much lower spending; in the high-touch model the average per member per month cost was $87 versus $121 in the more standard practice.  The additional cost of the outpatient visits and better drug use was more than offset by the reduction in spending on inpatient hospital.  The most significant implication of this study to me is that it shows the need for direct, personal and frequent interaction with patients to encourage them to take their health seriously and to keep after them about medication compliance and other actions that can prevent exacerbations of chronic diseases.