- Sustained value-based care program participation is key to realizing greater quality improvements for high-need patients that have two or more chronic conditions, a new American Journal of Managed Care study found.
The study of Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program from 2010 to 2013 showed that primary care practices that participated in value-based care programs over time experienced slight quality improvements for high-need patients. However, healthcare costs did not significantly go down for the patient population.
“Our findings specifically point to the importance of sustained participation, which likely helps practices establish new care processes to improve outcomes under their control—in particular, ED [emergency department] use and readmissions, which are more prevalent among high-need patients,” wrote study authors. “However, moving the needle on outcomes like total spending likely requires broader solutions that involve new approaches to health system organization and patient behavior change.”
Out of the 17,443 patients that had two or more chronic conditions and were continuously assigned to the same primary care provider, those who saw providers participating in the value-based care program saw greater overall quality and medication management improvements.
After four years of value-based care program participation, patients who saw participating providers experienced a 1.6 percent higher overall quality improvement compared to those who did not.
For the medication management quality measure, the high-need patient population in the value-care program also reported a 3 percent greater improvement compared to the control patient group.
In terms of healthcare service utilization, high-need patients who saw primary care providers in the value-based care program also experienced less hospital readmissions and emergency department use. Although, overall utilization of healthcare services was not significantly different.
Primary care practices in the value-based care program consistently reduced 30- and 90-day readmissions. From 2010 to 2013, sustained value-based care participation resulted in 25 less readmissions per 1,000 patients.
Compared to non-value-based care program providers, participating practices also lowered 30-day readmissions by 19.9 percent more and 27.5 percent more for 90-day readmissions over four years.
Emergency department utilization also decreased more over time among patients in value-based care program practices. The odds ratio of incurring any emergency department visit over time was 0.88 for patients at the value-based care program practices compared to non-participating practices.
However, researchers noted that the number of emergency department visits was not statistically different for both practice groups.
Similarly, the study showed that overall healthcare utilization for high-need patients was not significantly different among patients who saw a primary care provider in a value-based care program or not. Over the study period, value-based care program and non-program patients had similar odds of any hospitalization (0.93 odds ratio).
However, among patients with at least one hospitalization, patients who went to a value-based care program practice faced 5.7 percent more hospitalizations compared to control patients.
In terms of primary care and specialty visits, both patient groups did not differ in their odds of incurring any visits or the number of visits, researchers added.
Despite modest utilization and quality improvements, the study showed that value-based care program participation did not lower significantly healthcare costs over time. Practices in the value-based care program decreased medical and surgical costs for high-need patients by only 0.6 percent more than the control group.
Although, the study showed that patients at value-based care program practices had lower odds of incurring drug costs. Patients in the program decreased their odds of drug spending from an odds ratio of 0.88 in 2010 to 0.82 in 2013.
But researchers found that patients in the program who did incur drug costs experienced a steeper rate for total drug costs increases over time.
“[T]otal medical–surgical cost was not reduced, likely because avoided use was for relatively rare events and was partially compensated for by increased drug spending,” wrote study authors.
The study concluded that healthcare costs and quality improvements under value-based care programs take time. To realize benefits, practices need to sustain participation by changing organizational culture, promoting teamwork and care coordination, and increasing staff-level buy-in.
Promoting sustainable participation, however, will take multiple years, researchers stated. For example, quality improvements for high-need patients depend on increased care coordination. Providers need to develop and implement new systems and workflows for better patient transitions and data sharing in and out of their practices.
However, limited program effect on healthcare costs in the study may indicate that changes beyond a primary care practice’s control are needed to significantly decrease costs.
“Significantly improving these outcomes, even among high-need patients who offer the greatest opportunity for gains, likely requires broader changes to the health system and to patient behavior—both of which are complex and require a long time frame to address,” wrote study authors.
Despite modest improvements, researchers stated that value-based care programs are effective at improving quality of care for high-need patients.
“Given the large investment in pay-for-value programs to date, and their growing prominence, our findings offer reassurance that these initiatives appear to be effective in accelerating performance improvement among primary care practices caring for high-need patients,” concluded the study.