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The Financial Impact of Team-Based Care on Primary Care
Thomas E. Kottke, MD, MSPH; Michael V. Maciosek, PhD; Jacquelyn A. Huebsch, RN, PhD; Paul McGinnis, MD; Jolleen M. Nichols, RN; Emily D. Parker, PhD; and Juliana O. Tillema, MPA
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The Financial Impact of Team-Based Care on Primary Care

Thomas E. Kottke, MD, MSPH; Michael V. Maciosek, PhD; Jacquelyn A. Huebsch, RN, PhD; Paul McGinnis, MD; Jolleen M. Nichols, RN; Emily D. Parker, PhD; and Juliana O. Tillema, MPA
Although team-based care improved cardiovascular disease risk factors, it had a negative financial impact on a primary care practice.
However, patients who have CHD have a near-term risk of an event that is much higher than the risk for patients who have hypertension alone. This offers a number of near-term cost-reduction opportunities that are not available when caring for patients with hypertension. Total annual healthcare costs for patients with CHD have been reported to be $18,953 in 2008 dollars15—$6000 greater than the costs for patients who simply have hypertension.16 The cost of implementing team-based care that we computed earlier, $356 PPPY, is 1.9% of this total cost. It is indeed possible that team-based primary care could reduce costs for an accountable care organization to this extent by reducing acute and emergent events and low-value and no-value care.17 These savings could then be shared with primary care providers; however, until savings are shared, the additional cost of team-based care will be a barrier to the adoption of the strategy by primary care practices. 

Limitations

Our study has a number of important limitations. Some might consider a design that compared the intervention clinics with a set of parallel reference clinics to be a stronger design, but we were concerned that with such a design, unrecognized differences between patients in the intervention and control clinics might confound the results. Another weakness is the fact that the study was conducted in a single primary care practice with only 5 clinic sites and, because the team-based care model implemented to manage patients with CHD was new to the practice, it is possible that costs might decline as efficiencies developed over time.  The trial is also limited by the short time horizon.

CONCLUSIONS

The average annual cost of implementing team-based care in our trial for a patient with CHD could be recovered by an accountable care organization if team-based care reduced the total cost of treating a patient who has CHD by as little as 2%. In the current payment system, however, all of the costs, and none of the savings from team-based care, are borne by primary care. This suggests that primary care practices will not adopt team-based care and their patients will not experience the benefits until new payment models are developed and implemented.

Author Affiliations: HealthPartners Institute (TEK, MVM, JAH, EDP, JOT), Bloomington, MN; Hudson Physicians (PM, JMN), Hudson, WI.

Source of Funding: NIH grant R18HL096563 was the sole source of funding for the study.

Author Disclosures: Dr McGinnis was compensated for his time through the grant for this study. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (TEK, MVM, JAH, PM, JMN); acquisition of data (TEK, PM, JMN, EDP, JOT); analysis and interpretation of data (TEK, MVM, PM, JMN, EDP, JOT); drafting of the manuscript (TEK, MVM, EDP); critical revision of the manuscript for important intellectual content (JAH, TEK, MVM, PM, EDP); statistical analysis (MVM, EDP); obtaining funding (JAH, TEK); administrative, technical, or logistic support (JAH, JOT); and supervision (TEK).

Address correspondence to: Thomas E. Kottke, MD, MSPH, HealthPartners Institute, 8170 33rd Ave South, Mail Stop 21110X, Bloomington, MN 55425. E-mail: thomas.e.kottke@healthpartners.com.
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