Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial

Yoon J, Chang E, Rubenstein LV, Park A, Zulman DM, Stockdale S, Ong MK, Atkins D, Schectman G, Asch SM. Ann Intern Med. 2018 Jun 5. [Epub ahead of print] [CrossRef] [PubMed]

The authors assessed whether augmenting usual primary care with team-based intensive management lowers utilization and costs in patients at high risk for hospitalization. Locally tailored intensive management programs were created providing care coordination, goals assessment, health coaching, medication reconciliation, and home visits through an interdisciplinary team. 2210 patients were randomly assigned, 1105 to intensive management and 1105 to usual care. Patients had a mean age of 63 years and an average of 7 chronic conditions; 90% were men. From the pre- to post-randomization periods, mean inpatient costs decreased more for the intensive management than the usual care group (-$2164 [95% CI, -$7916 to $3587]). However, outpatient costs increased more for the intensive management than the usual care group ($2636 [CI, $524 to $4748]), driven by greater use of primary care, home care, telephone care, and telehealth. After adjustment for patient demographic factors and health conditions diagnosed during the year before randomization, total healthcare costs for patients in the intervention group were $471 higher than in the control group. Limitations of the study were that sites took up to several months to contact eligible patients, limiting the time between treatment and outcome assessment and it is unclear whether all costs were assessed, such as personnel costs. The authors conclude that high-risk patients with access to an intensive management program received more outpatient care but may actually modestly increase costs.