Care coordination and bloop singles

My former employer is bragging about research recently published by a Pitt Med School professor.  She is looking at the changes in cost of care for Veterans Administration patients because of a new integrated care model.

The VHA launched its Patient Aligned Care Teams (PACT) initiative in 2010, the largest program in the country to implement patient-centered medical home care. The VHA assigned each of the network’s 5 million primary care patients to a “teamlet” designed to provide multidisciplinary health care support focused on patients’ individual needs…..

a team of researchers… analyzed medical records from all 808 participating clinics

The 77 clinics that most fully executed the PACT model by 2012 had significantly larger improvements in five of seven chronic disease outcome measures and two of eight clinical process measures compared to the 69 clinics with the fewest PACT elements implemented. Researchers found that clinics with the most advanced PACT implementation saw 1 to 5 percent more of their patients meeting established levels for diabetes, blood pressure and cholesterol control.

1% to 5% improvements are not nothing. That is valuable. It makes the lives of those patients much better and it could conceivably lead to lower costs. It is also not a home run. It is not even a hard hit double that bounced around the wall near the power alleys. Instead it is a bloop single that landed in the grass halfway between the slap hitting second basemen and the no defense right fielder and the ball just died there.

Consistently being able to generate seeing eye singles can be an element of a long career as long as that player is able to add value somewhere else. It is not a hall of fame or system changing skill set though. In the same way, coordinating care helps on outcomes, it helps on process, it might help on costs and it may make the lives of patients better and easier at the same time. It probably won’t meaningfully bend the cost curve.

** The study is here

8 replies
  1. 1
    Amir Khalid says:

    Because it is a federal agency’s programme, because it benefits people, and because it is cost-effective, I fear for its continuation under die Regierung des Scheißgibbons.

  2. 2
    Sab says:

    @Amir Khalid: Me too, and I live in country, and have husband, children, grandchildren here. Hard to accept that 62,000,000 of my fellow countrymen want me and mine dead. But that’s where we are.

    Thanks Mayhew Anderson for all your work. Not many on the non-technical blogs covering your turf, and it is certainly needed.

  3. 3
    MomSense says:

    This looks like a really interesting study. Anecdotally, I have seen major improvements in the coordination of mental health providers and treatments. That’s a tough problem though because the participants are not always willing to work with their care team. House calls would be a big help.

  4. 4
    DonL140 says:

    I am a veteran who uses the VA system, and I am here to testify that it is great. Perfect? No, no system of any kind is perfect, but I believe there is plenty of evidence to say that the VA Healthcare system is the best in the world. You hear of politicians and the media criticizing it, but never vets. *Except those who complain about everything, anyway.

    I recently had a carpal tunnel procedure done, by a private surgeon, through the VA. There were some glitches, but the VA handled it smoothly. I got in to get an EKG in an hour, not the three months that some think is routine. The people who work for the VA are caring. It’s pretty amazing, and I’ve been with them for years. It would be hard for civilians to believe, given the reputation of socialized medicine.

    My father is a Tea Party conservative who rails against socialized medicine, yet raves about the care he receives from the VA. When explained to him that the govt owns the hospitals and the doctors are employees, which is really what socialized medicine is, the cognitive dissonance is obvious on his face.
    Then he changes the subject.

    The VA is what could be, if we had rational leadership.

  5. 5
    EMedPA says:

    As a clinician, I applaud efforts like the VA’s care teams, medical homes and the like. But if we really want to drive down costs, we’re going to look outside of care delivery. This is the best example I can think of off the bat: docs (and the rest of us in health care) can treat the patients in a cholera outbreak, but the outbreak won’t get solved until the contaminated water source is found and eliminated.

  6. 6

    @EMedPA: Better health would help, but the recent JAMA article on incremental cost drivers suggests it is more prices than anything else.

  7. 7
    EMedPA says:

    @David Anderson Interesting paper, which I will have to study in more detail. The fact that they didn’t address correlation between patient acuity and cost is a red flag to me, though. I’d also love to see a breakdown of where that money is getting spent: I would bet lunch that a lot of it is going into administrative salaries.

    Not that we don’t need to address prices in health care. It shouldn’t be news to any American that we pay way too much for a lot of unnecessary care, and get too little back in terms of outcomes. We need to deal with end of life care, drug prices, and value prevention more than intervention. Since all of that will require mature, reasoned conversation, and we live in a society that produced President Trump, I’m not confident that conversation will take place any time soon.

  8. 8
    ljdramone says:

    @Amir Khalid:

    … I fear for its continuation under die Regierung des Scheißgibbons.

    Hey, you missed a chance to coin a new German compound word!

    Na ja, jetzt leben wir alle unter Scheißgibbonsregierung.

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