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Integrated Care Delivery May Bring Better Outcomes, Lower Costs

According to a new study in the Journal of the American Medical Association, integrated care delivery in a primary care setting leads to better patient outcomes and reduces costs.

By Nathan Boroyan

- Integrated care delivery in a team-based primary care setting has the potential to provide better patient outcomes, fewer hospital visits and lower costs, according to a 10-year study conducted by Intermountain Healthcare.

Integrated care delivery system

Published in the Journal of the American Medical Association, the study shows the benefits of integrating healthcare and clinical services for primary care patients. The research focused on 113,452 patients between 2003 and 2013, including 27 team-based and 75 traditional practices.

"Team-based care means providers work together to care for all chronic conditions, mental and physical," said Brenda Reiss-Brennan, PhD, APRN, one of the authors of the study, in a press release. "At Intermountain, 80 percent of mental health services are provided by primary care physicians, and when they're supported by an integrated team, both they and their patients benefit."

Results showed that patients who received team-based primary care were screened at a much higher rate for depression than those in traditional practices, which has allowed for earlier interventions. In team-based practices, 46.1 percent of patients were diagnosed with depression, compared to only 24.1 percent in traditional care settings.

Team-based care patients also showed higher rates of engagement and meaningful chronic disease management than those in traditional practices. According to the study, 24.6 percent of patients receiving team-based care followed diabetes protocols, compared to only 19.5 percent of traditional care patients.

The study showed a significant discrepancy between team-based and traditional practices when it came to patient self-care plans. In team-based primary care settings a self-care plan was implemented 48.4 percent of the time, compared to just 8.6 in traditional settings.

In a team-based setting, patients used fewer healthcare providers and saw a reduction in their total cost of care.

Per 100 person years, the rate of emergency room visits by patients was lower in team-based settings (18.1%), compared to traditional settings (23.5%). Hospital readmission rates were also lower for patients in team-based care settings (9.5%), compared to traditional care settings (10.6%).

Patients receiving integrated care delivery fewer visits to primary care physicians. Per 100 person years, the number of physician visits by team-based care patients was 232.8, compared to 250.4 for traditional care patients.

Despite the upfront costs to implement an integrated care delivery model, the study proved there was value in the investment for Intermountain practices. In team-based care settings, providers were paid $3400, while providers in traditional practices received $3515.

The 3.3 percent savings was less than what it cost for Intermountain to create a team-based model.

"For patients, the bottom line of the study is that getting care in a team-based setting where medical providers work hand-in-hand with mental health professionals results in higher screening rates, more proactive treatment, and better clinical outcomes for complex chronic disease," said Reiss-Brennan.

“The study reinforces the value of coordinated team relationships within a delivery system and the importance of integrating physical and mental health care. The study provides further evidence — from a mental health perspective — of Intermountain Healthcare’s hypothesis that better care costs less.”


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