Focus on “high value items” in the main car

January 19, 2022A redesigned approach to patient-centered medical homes (PCMH) focusing on defined “high-value items” (HVEs) does not reduce healthcare costs for patients in primary care practicesreports a study in the February issue of Medical care. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Despite a downward trend in hospitalizations, the HVE approach was associated with an increased rate of emergency room visits and no change in total patient costs in participating primary care practices, according to the trial report cluster randomized by David A. Dorr, MD, MS, and colleagues at Oregon Health & Science University, Portland. “[I]in the face of other significant gaps in PCMH evidence to reduce cost and use, [the results] should push model developers and policy makers to consider significantly different approaches,” the researchers write.

Targeting HVE improves patient experience, but does not reduce healthcare costs

The PCMH approach – focusing on access to comprehensive, coordinated, team-based care – is a key part of efforts to improve quality while reducing excessive costs in the US healthcare system. More than half of primary care practices in Oregon report following the PCMH model. However, its impact on healthcare costs and utilization remains unclear.

With funding from the Gordon and Betty Moore Foundation, Dr. Dorr and his team have developed a novel PCMH approach focused on certain high-value items with evidence of effectiveness in reducing healthcare costs or utilization. . In early studies, the HVE approach produced an improvement in the care experience of patients. The new study evaluated the redesigned PCMH model for its ability to reduce costs of care in primary care clinics.

Eight clinics were randomly assigned to receive training or no training in the HVE approach. Clinics assigned to the new model chose from a “curated” list of HVEs identified as having the potential to improve patient outcomes while reducing cost and utilization – for example, team-based care for chronic disease management for patients with multiple or high impact diseases. Clinics in the comparison group followed standard PCMH goals.

HVE and non-HVE clinics received financial incentives, health information technology support, and practice facilitation to achieve quality improvement goals. Researchers analyzed health care cost and utilization data for more than 16,000 patients. Both groups of clinics were highly committed to their assigned approach and showed improvement toward achieving quality improvement goals.

However, there was no significant difference in costs for patients seen in HVE clinics compared to non-HVE clinics. Costs increased in both groups, with a difference between the groups of only about $100 per patient.

ER visits showed a slight increase for patients seen in HVE clinics, compared to a significant decrease in clinics receiving the standard quality improvement approach. There was a downward trend in patient hospitalization rates at HVE clinics, although the difference was only significant when comparing monthly means.

Despite significant research efforts, there is still only limited evidence for the use of PCMH approaches to reduce healthcare costs in primary care practice – especially for the small group of patients with high needs. which represent the largest share of costs. The researchers note some key limitations of their study, including the relatively small number of practices included and the complexity of the study intervention.

Despite high levels of engagement and promising effects on patient care experiences, the study “did not show clear cost and utilization benefits” with the HVE model, write Dr. Dorr and its co-authors. They conclude, “The ability to alter individual patient health trajectories with PCMH and advanced primary care models may be limited without team-oriented, patient-centered approaches.”

Click here to read “The Transforming Outcomes for Patients through Medical home Evaluation & redesign (TOPMED) cluster randomized randomization trial: Cost & utilization results”

DOI: 10.1097/MLR.0000000000001660


On Medical care

Ranked among the top ten journals in healthcare administration, Medical care is dedicated to all aspects of the administration and delivery of health care. This scientific journal publishes original peer-reviewed articles documenting the most recent developments in the rapidly changing field of health care. Medical care provides timely reports on the findings of original investigations on issues related to the research, planning, organization, financing, delivery and evaluation of health services. In addition, many special supplemental issues focusing on specialist topics are produced with each volume. Medical care is the official journal of the medical care section of the American Public Health Association.

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