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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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High-touch care can help build the physician–patient relationship, and this in turn could be associated with greater trust.23 Trust in healthcare relationships is a key ingredient of effective and high-quality care. Although the direct influence of trust on healthcare outcomes has long been recognized, it only recently has been proven to enhance behavior change and medication adherence.24

Our study also offers insights regarding which components are pivotal for high-intensity primary care programs. Those programs were proposed to manage medically complex and high-cost patients in an effort to decrease costs and provide better quality of care. A systematic review of the literature6 that included 379,745 participants and defined high-intensity care as primary care replacement (home-based care or clinic-based replacement) or primary care augmentation (by adding an interdisciplinary team) found varying degrees of effectiveness in reducing hospitalizations and limited evidence of improving mortality. The premier example of those high-intensity primary care initiatives is the Veterans Affairs Patient Aligned Care Teams model, which provides an integrated care team approach but found a modest increase in costs. A potential explanation is that veterans averaged 2.3 primary care visits per year, which may be insufficient to offset the costs of the program.

To our knowledge, there is no literature evaluating the effectiveness of a high-touch model of care. This may be explained by the recent emergence of the term “high-touch.” However, there is evidence that increasing primary care visits improve colorectal cancer screening rates,25 hypertension diagnosis,26 reduction in dialysis-related hospitalizations,27 and cardiovascular risk factor control,28 which supports our findings.

Our study contributes to the literature by comparing 2 models of delivering care to Medicare Advantage patients and revealing that among elderly patients, a higher frequency of patient–provider encounters can facilitate more effective care. Evaluating patients more often increases preventive and therapeutic opportunities and may improve the patient–physician relationship. It also provides concrete guidelines for practices seeking to implement high-touch care with respect to panel size, frequency of visits, and services provided.

Limitations

Our results should be viewed in the context of the following limitations. First, we matched for a limited number of factors known to affect the outcomes and could not match for other variables such as cardiovascular risk, social determinants of health, and principal diagnosis. However, we did match for the most important contributors to costs, such as comorbidity burden and age. Second, we had access only to claims data for both models of care; therefore, our analysis is subject to information bias. For this reason, we could not report on intermediate clinical outcomes, such as blood pressure or diabetes control, limiting our ability to test mediators of reduced costs. Third, the generalizability of the results is applicable only to at-risk practices that care for Medicare Advantage populations. Fourth, as in other high-intensity models, the high-touch primary care model tested in this study has components other than visit frequency that may play a role in outcomes, such as provider delivery of medications, in-house specialty care, and patient transportation.

CONCLUSIONS

Our study provides evidence that a high-touch preventive model providing frequent and easy access to primary, specialty, pharmacy, and ancillary care can improve healthcare utilization and reduce healthcare costs in spite of higher frequency of outpatient visits in a senior population. Future studies should evaluate the impact of this model on outcomes such as patient experience, medication adherence, and clinical outcomes.

Author Affiliations: Department of Medicine, Chen Senior Medical Centers (RG, GC, ED, AG, EF, TT, AP), Miami, FL; Miller School of Medicine at the University of Miami (LT, AP), Miami, FL; Veterans Affairs Medical Center (LT, AP), Miami, FL.

Source of Funding: None.

Author Disclosures: Dr R. Ghany, Ms Dawkins, Dr A. Ghany, Ms Forbes, and Mr Tajiri are employed by Chen Senior Medical Centers. Dr Chen is a board member and employee of Chen Senior Medical Centers. 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 (RG, LT, GC, AG, AP); acquisition of data (RG, LT, AG, TT); analysis and interpretation of data (RG, LT, ED, TT, AP); drafting of the manuscript (RG, LT, ED, AG, AP); critical revision of the manuscript for important intellectual content (RG, GC, ED, AG); statistical analysis (LT, TT); provision of patients or study materials (RG, GC, EF, TT); administrative, technical, or logistic support (ED, EF, TT); and supervision (GC, EF).

Address Correspondence to: Leonardo Tamariz, MD, MPH, University of Miami, 1120 NW 14th St, Ste 1124, Miami, FL 33136. Email: ltamariz@med.miami.edu.
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