Value-Based Comprehensive Primary Care in Action

Once more into the breach on a questionable health intervention.  We spend a lot of money on health care in the US.  Not clear people’s health is getting better, although generally people get good care for all those health problems we have.  A big rage for over a decade has been a belief that if we just had primary care doctors really focussed on managing their patients’ health intensely, we would both spend less and patients’ health would be better.  Sounds good, right!!  So we have had a bunch of iniatives, often driven by Medicare, to test this nice theory.  One is the Comprehensive Primary Care Plus program, which involved not just Medicare, but private payers as well.  Primary care physicians were paid more to manage care more carefully.  Medicare’s evaluation of the program has shown almost no positive effects.  This study looked at results for private payers in Michigan over a seven-year period.  The outcomes were both quality of care and spending.

I regret to inform you, not unexpectedly to me, that there was only a very minor and statistically insignificant reduction in spending compared to similar group not involved in the program and almost no change in quality of care.  If you include extra payments to physicians, the spending was actually higher.  Again, doesn’t mean getting primary care doctors to pay more attention to their patients’ totality of care isn’t a good idea, but it does appear that it may not have huge spending or quality impacts.  (HA Study)