New Research Confirms Doctors Participating in Practice Improvement and Patient Management Programs Cost Less, Have Better Patient Outcomes
HCI3 analysis of claims data finds programs like Patient-Centered Medical Home and Bridges to Excellence most effective for patients with chronic conditions
NEWTOWN, CT — May 4, 3012 — Physicians participating in practice improvement and patient management programs such the Patient-Centered Medical Home (PCMH) and Bridges to Excellence (BTE) realize better cost performance for patients with chronic conditions than their non-Recognized peers, according to recent research released today by the Health Care Incentives Improvement Institute™, Inc. (HCI3).
The Patient-Centered Medical Home is an approach to providing comprehensive primary care and pilots are being supported by the Patient Centered Primary Care Collaborative. Managed by HCI3, a non-profit focused on improving health care quality and value through evidence-based incentive and payment solutions, BTE is a family of programs to reward Recognized physicians who meet certain performance measures. The results are available in the latest HCI3 Improving Incentives Issue Brief.
“Overall, these findings support emerging evidence on the use of practice-based systems that underlie the accreditation criteria for both programs,” said Meredith B. Rosenthal, professor of Health Economics and Policy, Harvard School of Public Health. “In particular, studies are finding that improved population management focusing on chronic illness can impact inpatient utilization and/or emergency department visits.”
PCMH-recognized physicians participating in pilots had a favorable cost performance amounting to approximately $12 per chronically ill member per month. BTE Diabetes-Recognized physicians had a favorable cost performance of approximately $36.50 per member with diabetes per month. The better performance was tightly associated to the management of certain patients for which quality measures were reported, and did not extend to other patients with chronic illness for whom quality metrics were not reported. These amounts, while not negligible, might be underestimating the full potential impact of PCMH practices on total plan member costs. However, the current findings also put into question the sometimes sizable per member per month payments made by private and public sector plans to PCMH-recognized practices.
“While PCMH and BTE-recognized physicians have a better cost performance than their non-recognized peers, that better performance seems to be limited to the chronic conditions for which they are actively reporting quality outcomes,” said Francois de Brantes, HCI3 Executive Director.
The analysis found the current per member per month incentives paid for PCMH may be somewhat inflated. Health plans are paying on average between $15-20 per member per month, while the costs savings for chronically ill patient is $12 or roughly $144 annually.
“The effect of good management on some patients with chronic conditions does not appear to spill over to other patients,” de Brantes emphasized. “As such, employers as one of the largest purchasers of health care should (a) continue to pursue incentives for physicians to become recognized, (b) tie those incentives as much as possible to actual cost performance, and (c) tie all incentives to comprehensive quality scorecards that look at outcomes across patients with different chronic conditions, and not simply a slice of them.”
Patients and Method
HCI3 performed an analysis of claims data using its PROMETHEUS Evidence-informed Case Rate (ECR) analytics software of commercially insured members from multiple health plans across the United States. The analysis included claims data which ranged from 2008-2010, covering 668,604 member lives, triggering 87,377 chronic episodes of care, and included 6,650 primary care physicians. Patients with one or more of six chronic conditions (Diabetes, Hypertension, Coronary Artery Disease, Chronic Obstructive Pulmonary Disorder, Asthma, and Gastro-esophageal Reflux Disease) were identified using the coding rules and clinical logic included in the software package.
About the Health Care Incentives Improvement Institute™, Inc.
The Health Care Incentives Improvement Institute, Inc. (HCI3®) is a non-profit multi-stakeholder umbrella organization for Bridges to Excellence® and PROMETHEUS Payment®. The mission of the organization is to create significant improvements in the quality and affordability of health care by developing and implementing programs that recognize and reward physicians, hospitals and other health care providers that deliver safe, timely, effective, efficient, equitable and patient-centered care. HCI3 offers a comprehensive package of solutions to employers, health plans and coalitions to improve the flawed incentives that currently permeate the U.S. health care system. www.HCI3.org
# # #