Quantifying Costs of a Medical Home Transformation for Seniors ABSTRACT: The proposed project aims to generate evidence about the costs of implementing Patient Centered Medical Home (PCMH) components by comparing costs of a wellness care redesign for older adult patients of HealthCare Partners Medical Group (HCP), an integrated medical group with 31 practice sites, and 213 practices sites of HCP's network of Independent Practice Associations (IPAs), totaling 244 primary care practice sites in the greater Los Angeles area. Previous research has underscored that patients of integrated medical groups receive higher quality of care and report better experiences of care compared to patients of IPA physicians (1, 2). No research, has examined the resource requirements and costs for managing the preventive care of clinically complex older adult patients across these organizational models. Transforming small primary care practices into PCMHs has been very difficult for clinicians and staff of small practices because of the limited quality improvement (QI) infrastructure and practice redesign experiences available in IPA settings (3). Consequently, start-up and incremental expenses are likely to be higher in IPA practices with extensive coordination costs due to providing more services off-site. We hypothesize that the start-up costs and incremental expenses associated with senior wellness care redesign will be lower, on average, for primary care practice sites in the integrated medical group compared to the IPA primary care practice sites. HCP is an Accountable Care Organization (ACO) at the forefront of testing innovations for delivering chronic illness care to diverse patient populations. To further examine "real world" cost impacts of PCMH implementation, UCLA, HCP Medical Group, and the HCP Institute for Applied Research and Education propose to partner to: 1. Develop a cost capture template (CCT) for the senior wellness care redesign using the "Prescription for Health" (P4H) framework of cost estimation, 2. Retrospectively quantify start-up, incremental and staff practice expenses corresponding to the senior wellness care redesign in HCP's integrated primary care practices (PCPs), 3. Compare the start-up, incremental and staff expenses for site- level implementation of the PCMH redesign between HCP's and IPAs'PCPs and perform sensitivity analyses.
PCMHs aim to foster long-term relationships between patients and healthcare providers to more effectively manage ongoing health conditions and improving treatment adherence. The relative costs of fostering patient- centered wellness care for older adult patients, however, have not been explored. To our knowledge, no study has simultaneously estimated start-up and incremental practice expenses for PCMH transformation and compared these costs in primary care practices of integrated medical groups and IPAs. The proposed comparative cost analyses will be completed in 18 months. The results will benefit policy leaders and public and private healthcare organizations when resourcing implementation of PCMH components and incentivizing practice changes to improve care for older adults with multiple chronic conditions in diverse PCP settings.

Public Health Relevance

Quantifying Costs of a Medical Home Transformation for Seniors PROJECT NARRATIVE: The proposed research will contribute to the development of an unexplored area of research: estimating the cost of a multi-site senior wellness redesign that employed principles of the patient centered medical home (PCMH) model. Because little is known about transformation costs in diverse practice settings, we compare implementation costs in integrated group primary care practices and IPA primary care practices. The proposed research will contribute to the broader understanding of how costs differ for a PCMH redesign based on primary care practice organization and infrastructure.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Small Research Grants (R03)
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Special Emphasis Panel (ZHS1-HSR-O (01))
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Mcnellis, Robert
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University of California Los Angeles
Public Health & Prev Medicine
Schools of Public Health
Los Angeles
United States
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