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The American Journal of Managed Care September 2018
Food Insecurity, Healthcare Utilization, and High Cost: A Longitudinal Cohort Study
Seth A. Berkowitz, MD, MPH; Hilary K. Seligman, MD, MAS; James B. Meigs, MD, MPH; and Sanjay Basu, MD, PhD
Language Barriers and LDL-C/SBP Control Among Latinos With Diabetes
Alicia Fernandez, MD; E. Margaret Warton, MPH; Dean Schillinger, MD; Howard H. Moffet, MPH; Jenna Kruger, MPH; Nancy Adler, PhD; and Andrew J. Karter, PhD
Hepatitis C Care Cascade Among Persons Born 1945-1965: 3 Medical Centers
Joanne E. Brady, PhD; Claudia Vellozzi, MD, MPH; Susan Hariri, PhD; Danielle L. Kruger, BA; David R. Nerenz, PhD; Kimberly Ann Brown, MD; Alex D. Federman, MD, MPH; Katherine Krauskopf, MD, MPH; Natalie Kil, MPH; Omar I. Massoud, MD; Jenni M. Wise, RN, MSN; Toni Ann Seay, MPH, MA; Bryce D. Smith, PhD; Anthony K. Yartel, MPH; and David B. Rein, PhD
“Precision Health” for High-Need, High-Cost Patients
Dhruv Khullar, MD, MPP, and Rainu Kaushal, MD, MPH
From the Editorial Board: A. Mark Fendrick, MD
A. Mark Fendrick, MD
Health Literacy, Preventive Health Screening, and Medication Adherence Behaviors of Older African Americans at a PCMH
Anil N.F. Aranha, PhD, and Pragnesh J. Patel, MD
Early Experiences With the Acute Community Care Program in Eastern Massachusetts
Lisa I. Iezzoni, MD, MSc; Amy J. Wint, MSc; W. Scott Cluett III; Toyin Ajayi, MD, MPhil; Matthew Goudreau, BS; Bonnie B. Blanchfield, CPA, SM, ScD; Joseph Palmisano, MA, MPH; and Yorghos Tripodis, PhD
Economic Evaluation of Patient-Centered Care Among Long-Term Cancer Survivors
JaeJin An, BPharm, PhD, and Adrian Lau, PharmD
Fragmented Ambulatory Care and Subsequent Healthcare Utilization Among Medicare Beneficiaries
Lisa M. Kern, MD, MPH; Joanna K. Seirup, MPH; Mangala Rajan, MBA; Rachel Jawahar, PhD, MPH; and Susan S. Stuard, MBA
Currently Reading
High-Touch Care Leads to Better Outcomes and Lower Costs in a Senior Population
Reyan Ghany, MD; Leonardo Tamariz, MD, MPH; Gordon Chen, MD; Elissa Dawkins, MS; Alina Ghany, MD; Emancia Forbes, RDCS; Thiago Tajiri, MBA; and Ana Palacio, MD, MPH

High-Touch Care Leads to Better Outcomes and Lower Costs in a Senior Population

Reyan Ghany, MD; Leonardo Tamariz, MD, MPH; Gordon Chen, MD; Elissa Dawkins, MS; Alina Ghany, MD; Emancia Forbes, RDCS; Thiago Tajiri, MBA; and Ana Palacio, MD, MPH
Evaluating the impact of a high-touch primary care model among a Medicare Advantage population in comparison with a standard practice–based model.
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ABSTRACT

Objectives: There are several models of primary care. A form of high-intensity care is a high-touch model that uses a high frequency of encounters to deliver preventive services. The aim of this study is to compare the healthcare utilization of patients receiving 2 models of primary care, ​1 with high-touch care and 1 without.

Study Design: Retrospective cohort study.

Methods: We conducted a retrospective cohort study of 2 models of care used among Medicare Advantage populations. Model 1 is a high-touch care model, and model 2 is a standard care model. Compared with model 2, model 1 has smaller panel sizes and a higher frequency of encounters. We compared patients’ healthcare utilization and hospitalizations between both models using a propensity score–matched analysis, matching by Charlson Comorbidity Index (CCI) score, age, and gender.

Results: We included 17,711 unmatched Medicare Advantage primary care patients and matched 5695 patients from both models of care. CCI scores, age, and gender were similar between both matched groups (P >.05). The median total per member per month healthcare costs in model 1 were $87 (95% CI, $26-$278) compared with $121 (95% CI, $52-$284) in model 2 (P <.01). The mean number of hospital admissions was lower in model 1 (0.10 ± 0.40) compared with model 2 (0.20 ± 0.58). The number of primary care physician visits and preventive medication use were higher in model 1 (P <.05 for both).

Conclusions: In a propensity-matched sample of Medicare Advantage patients, those receiving high-touch care had lower healthcare costs and fewer hospitalizations. Potential explanations are higher preventive medication use and more frequent visits.

Am J Manag Care. 2018;24(9):e300-e304
Takeaway Points
  • Studies evaluating the use of high-intensity care have produced inconsistent results.
  • We used a retrospective cohort study to evaluate the impact of high-intensity care, defined as a high-touch primary care model, among a Medicare Advantage population in comparison with a standard practice–based model.
  • There were differences in healthcare costs, admission rates, and use of preventive medication between both models.
In the United States, 46 million people are 65 years or older. The elderly population is expected to double by 2030. Advancing age is associated with increasing number of comorbidities, number of healthcare needs, and costs. Caring for chronic conditions in this age group costs the United States more than $617 billion per year.1

Over the past decade, a number of healthcare initiatives, mostly supported via the Affordable Care Act, have been deployed in an attempt to improve quality of care and curtail costs. The Veterans Health Administration and CMS have mandated quality reporting and set up mechanisms to incentivize preventive strategies.2

CMS has also encouraged health systems and providers to identify effective models of healthcare delivery. Among those are high-intensity models of care. The National Institute for Health Care Reform defines high-intensity care as “care provided by a multidisciplinary team for patients with complex conditions to improve care and lower healthcare costs.”3 A type of high-intensity care model is one that encourages frequent direct person-to-person interaction between patients and their healthcare providers to optimize the value of care.4,5 An emerging name for this model subtype is high-touch care.3 This optimization is achieved by frequent visits to focus on outcomes and an encounter framework that facilitates adherence to treatment plans and behaviors that prevent disease or complications. Although there is some evidence that high-intensity primary care reduces hospitalizations,6 the interventions evaluated have multiple components, limiting our ability to measure the effectiveness of high-touch primary care. However, clinical trials like the Systolic Blood Pressure Intervention Trial have shown that frequent visits were necessary to achieve aggressive control of blood pressure and in turn reduce mortality in elderly patients with high cardiovascular risk.7 This was found to be a cost-effective strategy.8

The aim of this study was to evaluate the impact of a high-touch model of primary care on healthcare utilization among Medicare Advantage patients compared with a standard practice-based model.

METHODS

Study Design and Population

We conducted a retrospective cohort study to evaluate the clinical and economic effects of 2 models of care: high-touch care versus standard practice. Both models of care included only seniors with Medicare Advantage insurance. The study was approved by Western Institutional Review Board (IRB) and the University of Miami IRB.

Description of Models of Care

The high-touch model (model 1) is a high-intensity primary care model4,5 that delivers care through very frequent patient–provider encounters aimed at preventing or delaying the occurrence of complications of chronic conditions. Chen Senior Medical Centers is a multispecialty organization spread over 7 states. Its model of care is based on the following pillars: (1) a preventive cardiovascular program9,10; (2) in most states, on-site medication dispensing by providers; (3) smaller patient panels of approximately 450 patients per primary care physician (PCP), allowing providers to spend more time with each patient; (4) very frequent encounters, with a mean of 189 minutes per year of face time3; (5) an advanced electronic health record (EHR) system; (6) courtesy transportation for all patients; and (7) walk-in hours. We included all Chen Medical members who had Medicare Advantage plans and were seen in any of the Chen Medical practices between January 2, 2014, and March 27, 2015.

The control model (model 2) delivers care at a frequency consistent with usual marketplace benchmarks. This site is also a multispecialty practice that has a main campus and 2 other satellite offices. Although the control groups’ practices offer a traditional model of care at their centers, they do offer (1) preventive services, such as bariatric weight loss surgery; (2) an in-house pharmacy where prescriptions can be filled using an online link; (3) limited laboratory tests and basic x-rays; (4) an EHR system that is accessible to their patients; (5) close PCP follow-up, with mean face time of 90 minutes per year; and (6) access to care that involves walk-in hours and an urgent care center that is open on weekends and holidays. However, model 2 does not offer courtesy transportation to its patients, has larger patient panels, has patients seen less often by their PCPs, and does not have transitional care teams (Table 1).


 
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