Examining the Costs of a Medical Home Transformation for Seniors

Principal Investigator: Arturo Vargas-Bustamante, PhD, MPP, MA
Institution: University of California, Los Angeles
AHRQ Grant Number: R03 HS22634

Overview of Estimating Costs Grant

This grant examines the costs of a wellness care redesign for older adult patients. The redesign was completed between 2009 and 2012 in an integrated medical group and in 213 independent practice associations (IPAs) in its network. The integrated medical group, HealthCare Partners Medical Group, is an Accountable Care Organization in the greater Los Angeles area with 31 practice sites. The study compares the costs of transformation across three regions and two organization types (integrated medical group vs. IPA).

The primary goals of the redesign were to improve the quality of patient–primary care team interactions, support shared decisionmaking, and help coordinate preventive and chronic patient care needs. The primary focus of the redesign was to reduce the burden on primary care physicians, allowing them more time to focus their efforts on improving diabetes, depression, and cardiovascular care management for seniors.
Within the integrated medical group, each practice site was allocated medical assistant resources to support the redesign processes. Medical assistants reviewed patient charts to identify preventive and chronic care needs, held previsit calls to assess patient-reported needs, conducted previsits prior to primary care provider visits to assess concerns and needs and review test results, and participated in daily huddles on the needs and supports of each patient. In addition, patient visits with primary care providers were extended to better address patient needs.

In the IPAs, nurse practitioners implemented the new processes. Staff received training to proactively identify patient needs and preferences.

Costs estimated included startup and incremental practice expenses for patient-centered medical home (PCMH) transformation, including the cost of creating and updating staff training materials; costs of staff time spent on patient recruitment, attending trainings, and patient visit time; equipment costs (medical equipment and office supplies); and incidental costs (transportation and incentives).

To facilitate collection of cost information and improve the reliability of cost estimates, the research team focused on items that would be required by other organizations that may be interested in replicating a similar senior wellness care redesign in their respective organizations. Costs that were difficult to estimate retrospectively and either did not account for a significant share of the costs of transformation or were not central to the implementation of the senior care redesign were excluded. Further, the study did not account for fixed costs; it only accounted for variable costs or costs associated with implementing and sustaining the key redesign components.