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Team-based care linked to higher quality of care, lower payments

Primary care services using team-based care, as opposed to traditional practice management, were associated with higher rates of quality of care measures, lower rates of acute care utilization measures, and lower rates of payments received by the care delivery system, among adults enrolled in integrated health care systems, according to data published in JAMA.

“Limited evidence is available to support the utility of medical home and accountable care integration with mental health and primary care teams,” Brenda Reiss-Brennan, PhD, of Intermountain Healthcare, in Salt Lake City, and colleagues wrote. “In 2000, Intermountain Healthcare (hereafter referred to as Intermountain), a fully integrated delivery system, attempted to address this evidence gap by incorporating physical and mental health interdisciplinary teams in patient care…. This program has been deployed within local clinic and has been sustained across diverse primary care practices (family medicine, pediatrics, and internal medicine) over the past 16 years.”

To analyze the link between receiving primary care through integrated team-based practices, as opposed to traditional practices, and patient outcomes, care use and costs, the researchers conducted a retrospective, longitudinal cohort study among adult patients at Intermountain in internal medicine, family practice and geriatrics practices.

Included were 113,452 patients aged 18 years or older who received primary care at 113 unique Intermountain medical group practices from 2003 through 2005, and had annual encounters with the medical system through 2013. Some patients received care in both team-based and traditional practices. The participants accounted for 163,226 person-years of exposure in 27 team-based practices, and 171,915 person-years in traditional practices.

According to the researchers, patients in the team-based practices had higher rates of active depression screening (46.1% for team-based vs. 24.1% for traditional; OR = 1.91; 95% CI, 1.75-2.08), adherence to diabetes care bundle (24.6% for team-based vs. 19.5% for traditional; OR = 1.26; 95% CI, 1.11-1.42), and documentation of self-care plans (48.4% for team-based vs. 8.7% for traditional; OR = 5.59; 95% CI, 4.27-7.33). In addition, team-based practices had a lower proportion of patients with controlled hypertension, defined as < 140/90 mm Hg, (85% for team-based vs. 97.7% for traditional; OR = 0.87; 95% CI, 0.8-0.95), and no significant differences in documentation of advanced care directives.

In addition, per 100 person-years, rates of health care use among patients in team-based practices were lower for ED visits (18.1 for team-based vs. 23.5 for traditional; IRR = 0.77; 95% CI, 0.74-0.8), hospital admissions (9.5 for team-based vs. 10.6 for traditional; IRR = 0.89; 95% CI, 0.85-0.94), ambulatory care sensitive visits and admissions (3.3 for team-based vs. 4.3 for traditional; IRR = 0.77; 95% CI, 0.7-0.85), and PCP visits (232.8 for team-based vs. 250.4 for traditional; IRR = 0.93; 95% CI, 0.92-0.94). There were no significant differences in visits to urgent care facilities and visits to specialty care physicians.

Payments to the delivery system among the team-based practices were also lower ($3,400.62 for team-based vs. $3,515.71 for traditional; β −$115.09; 95% CI, −$199.64 to −$30.54), and were less than investment costs of the team-based care program.

“In this observational study, receipt of primary care in [team-based care] practices, compared with [traditional practice management] practices, was associated with significantly higher rates of some quality of care measures, reductions in some measures of acute care utilization, and decreased actual payments to the delivery system from all payers and patients,” Reiss-Brennan and colleagues wrote. “Compared with [traditional practice management], [team-based care] also was associated with improved quality of care for patients with depression and diabetes, but with decreased quality for patients with hypertension…. The study suggests the value of coordinated team relationships within a delivery system emphasizing the integration of physical and mental health care.” – by Jason Laday