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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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Medication Use

Table 4 shows medication use by model of care. Medications were used more frequently in model 1. The absolute differences in percentage points (PPs) were 41 PPs for aspirin, 22 PPs for statins, 36 PPs for ACE inhibitors and ARBs, 26 PPs for β-blockers, and 22 PPs for diuretics when comparing models 1 and 2 (P <.01 for all).

Healthcare Utilization

Table 5 shows healthcare utilization by model of care. The PMPM healthcare costs for model 1 were $87 (95% CI, $26-$278) compared with $121 (95% CI, $52-$284) in model 2 (P <.01). The mean number of admissions was lower in model 1 (0.10 ± 0.40) compared with model 2 (0.20 ± 0.58; P <.01).

DISCUSSION

Our study found that in a propensity-matched sample of seniors insured through Medicare Advantage, those who received high-touch care had lower healthcare costs and fewer hospitalizations than a matched group of patients receiving standard care in a similar value-based model that attracts patients who are clinically high-risk. Care model 1 had a higher number of encounters between patients and providers and was associated with higher use of cardiovascular medications.

We hypothesize that 3 potential mediators may explain the lower costs in the high-touch model of care. First, the greater interaction between patients and providers may allow for better optimization of medications and promote better adherence, leading to higher use of evidence-based medications. Others have reported that facilitating patient–physician communication can optimize the use of medications18,19 and help develop an environment of accountability and trust that facilitates behavior modification. As an example, informing patients of their treatment targets after acute coronary syndromes significantly increased adherence to evidence-based therapies.20 Similarly, clinical inertia is a frequent cause of undertreatment of chronic conditions among the elderly.21

A high-touch model that focuses on patient outcomes and establishes a culture of seeing patients as frequently as needed to prevent complications may help providers favor a more aggressive approach toward treatment. Future studies should evaluate this possibility. Nevertheless, our findings support the fact that the high-touch model may lead to higher use of cardiovascular medications known to improve control of blood pressure and cholesterol and reduce cardiovascular outcomes. The fact that the standard-of-care comparison group (model 2) also had on-site dispensing of medications reduces potential confounding related to the ability to fill prescriptions. However, in the case of model 1, medications are usually delivered by the provider during the patient visit, thus facilitating the quality of communication regarding prescribed medications.13

A second potential explanation for the healthcare cost reduction seen in the high-touch model is that it may allow the more timely diagnosis of ambulatory care–sensitive conditions (ACSCs), leading to a lower mean number of hospital admissions, an important driver of healthcare costs.22 Common causes for hospitalization due to common ACSCs include lack of or delayed access to care, suboptimal monitoring, and medication nonadherence. Therefore, recommended strategies to avoid such hospitalizations include those that are intrinsic parts of a high-touch model: easy access to care, monitoring of outcomes and medication adherence, transition teams, and communication among providers.

Third, because patients in the high-touch care model were seen more often than those in the standard care model, they may better adhere to other preventive care strategies, such as vaccination or cancer screening. The role that high-touch models of care can have in avoiding hospitalizations for ACSCs and in preventive care needs to be rigorously studied.


 
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