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Team-based primary care may improve CHD, lower costs

Researchers found that team-based primary care may be beneficial in improving coronary heart disease risk factors and lowering health care costs, but patients may only reap these benefits if the current care payment system is restructured.

“We hypothesized that, because patients with [coronary heart disease (CHD)] are at a much higher risk of another cardiac event in the near term, it might be possible to implement a team-based care system that would be revenue-neutral or revenue-positive for primary care,” Thomas E. Kottke, MD, MSPH, at the HealthPartners Institute in Bloomington, Minn., and colleagues wrote. “In this report, we describe the results of our attempt to design and implement such a system in partnership with a private practice that comprised five clinic sites.”

To evaluate team-based approaches to minimizing CHD risk factors and their effect on costs, revenue and use of a private primary care practice, the researchers partnered with a private medical practice at their five clinic sites between 2010 and 2013. They assisted in delivering team-based care for patients with CHD. Using billing records and the registered nurse care manager’s diary, they calculated costs of team-based care, differences in average number of visits per patient and revenue per patient, before and after introducing team-based care.

The pre-implementation CHD sample comprised 635 patients, and the post-implementation sample comprised 534 patients. The researchers determined that the net cost of team-based primary care per patient was $291 over the 1-year observation period. Prior to implementation of team-based care, the average number of total visits per patient was 9.2, the average number of visits with a provider was 4.4 and the average revenue per patient was $878. After implementation of team-based care, the average number of total visits per patient was 8.7, the average number of visits with a provider was 4, and the average revenue per patient was $779. Overall, statistical modeling predicts a 2.5% net decline in revenue per patient.

“The average annual cost of implementing team-based care in our trial for a patient with CHD could be recovered by an accountable care organization if team-based care reduced the total cost of treating a patient who has CHD by as little as 2%,” Kottke and colleagues wrote. “In the current payment system, however, all of the costs, and none of the savings from team-based care, are borne by primary care. This suggests that primary care practices will not adopt team-based care and their patients will not experience the benefits until new payment models are developed and implemented.”

 – by Rafi Naseer

Disclosure: McGinnis reports compensation for his time through the NIH grant for this study. The remaining researchers report no relevant financial disclosures.