Results of a two-year study are in, and the prognosis is good news for the Patient-Centered Primary Care Home (PCPCH) program. Total patient service expenditures decreased overall by 4.2 percent per person or approximately $41 per quarter (about $13.50 per person each month) between 2012 and 2014.
A particularly noteworthy finding of the study, conducted by Portland State University (PSU), was the doubling of these savings between the first and third year of a clinic’s PCPCH designation. In other words, as the clinic’s PCPCH participation progressed to the third year, the overall program savings per person doubled to 8.6 percent or $85 per person per quarter (approximately $28 per month).
The Oregon Legislature established the PCPCH program in 2009 with the intent to encourage more patients to use primary care services in place of more costly specialty care and emergency services. Confirmed by the PSU study, the program resulted in an average of $13 savings for patients in other services such as specialty services, emergency department and inpatient care for every $1 increase in patient expenditures on primary care.
Led by Sherril Gelmon, DrPH, director of the Health Systems and Policy PhD Program at Oregon Health & Science University and PSU School of Public Health, researchers recently completed the third phase of a multi-year program evaluation identifying a spirit of continuous improvement from exemplary clinics and willingness to adopt a “patient-centered lens.”
“The findings of this report show that the program is definitely helping Oregon to work toward accomplishing the Triple Aim. Our findings show that the PCPCH program is facilitating the transformation, transition and adoption of patient-centered care, and primary care clinics are beginning to adopt population-based strategies,” Gelmon said in a phone call with The Lund Report.
The Triple Aim goals, defined by the Oregon Health Policy Board Action Plan, are to improve the health of all Oregonians while increasing quality, reliability and availability of care, and lowering the cost of care so that it is affordable to everyone.
In response to rising healthcare costs consuming an ever-increasing portion of the state’s budget, Oregon’s mandate was to develop and implement a patient-centered approach to healthcare. The PCPCH defining characteristics are collaborative
relationships between clinics, patients and their families, and a more efficient and compassionate approach to determining health needs and goals.
Housed within the Oregon Health Authority (OHA) Transformation Center, the PCPCH program fulfills a vision to stabilize rising healthcare costs through innovative methods within the coordinated care model. The program recognizes clinics offering high-quality healthcare while breaking down barriers between patients and good health.
PSU evaluated the PCPCH program implementation processes to determine what was working well and areas for improvement. Results of the study were published in September and then presented at the Cost of Care (CCO) Oregon conference held in December. The evaluation report is available here at the OHA Transformation Center. To access the report directly, click here.
The PSU evaluation had three aims: 1) examine the organizational conditions and process improvement activities of exemplary practices, 2) analyze the impacts of the program on the utilization and expenditures of patients, and 3) determine the ability of the scoring to evaluate the program’s performance.
The study’s executive summary outlined findings of the program’s successful elements and recommendations for how to address the issues. In addition to reducing service expenditures, the program encouraged clinics to embrace team-based care, shared decision-making and more awareness of patient goals.
“Overall, the program is working well but there is always room for improvement. At the systems level, there are problems with the payment model, and the state will need to determine whether it can fiscally incentivize clinics for their PCPCH work. There are also systems-level issues related to health information exchange because there is a lack of interoperability between hospitals and clinics since they are using different EHR platforms (electronic health records). These are huge issues to grapple with, and need attention from OHA,” said Gelmon.
Neal Wallace, PhD, PSU professor of Health Systems Management and Policy and co-principal investigator for the evaluation, conducted a quantitative analysis of the Oregon All Payer All Claims (APAC) data for both recognized PCPCH and other clinics. The analysis looked at pre and post effects of implementing the program requirements compared to clinics that were not designated.
“We found that the longer the clinics were a designated PCPCH, the more there were decreases in costs in all but primary care and pharmacy. This was expected and hoped because primary care is upstream care and therefore more preventative and less expensive. One would hope these upstream investments would lead to decreases in other downstream services such as those within the institutions contributing to more efficiency and decreased costs,“ said Dr. Wallace.
PCPCH-designated clinics focus on six core attributes: access to care, accountability, comprehensive whole-person care, continuity, coordination and integration, person and family-centered care.
For patients and families, the program’s core attributes translates into availability of high quality healthcare services when they need it and getting help navigating the system. The clinics ensure that there will be someone available to listen to any concerns and answer questions. Clinics should offer after-hour help and alternatives to the emergency room
Overall, clinics encourage patients to play a more active role in their healthcare. However, one of the issues brought forward in the findings was the difficulty in relaying the PCPCH value and benefits to patients. They sometimes resist the shared decision-making healthcare model.
The report concluded that the PCPCH clinics made considerable achievements and transformation in just a few short years though these were not easily obtained. For continued success, the clinic leaders will need support from the larger health systems environment.
Without financial incentives provided for the program, clinics struggle with the costs of making the institutional changes needed to implement the PCPCH core attributes and meet the requirements (of both general and top-tier recognition). “OHA has many issues to deal with, but these are some of the recommendations we have made,” noted Gelmon.
On a final note, Wallace said: “What’s unique about Oregon is that there are resources such as statewide learning collaboratives helping to get people up to speed on the PCPCH program. Also it’s a multi-tiered program so clinics can get in and work their way up in the system. It takes a lot of effort to do this program and clinics need support to learn and implement the highest tier levels.”
Kathryn can be reached at [email protected].
