It goes against the grain, but the higher the proportion of high-needs patients that primary care practices treat, the better the care they are able to provide.
That was one finding of a new study published in Health Affairs that looked at whether certain types of primary care practices are better able to respond to high-needs patients who have multiple physical, mental or behavioral conditions.
Researchers looked at four years of data from more than 1,300 primary care practices in Michigan that cared for Blue Cross Blue Shield of Michigan beneficiaries and considered whether two factors—the proportion of patients in the practice that were high-needs and the number of physicians—could predict how well they delivered care to this population.
Practices with a higher number of patients, especially more than 10% of their panel, had lower spending and utilization of services such as inpatient admissions, emergency department visits and specialist visits compared to practices with smaller proportions. The researchers said those practices may have structural advantages or may have developed specialized approaches to better serve their high-needs patients.
“These findings are somewhat surprising, given that high-needs patients require more time, resources and expertise to effectively manage their care. It may be that practices with a greater proportion of complex patients reach a ‘tipping point’ where they have gained the experience and economies of scale necessary to effectively target care processes to this population’s unique needs,” the researchers said.
The researchers said more study is needed, because improving care for these patients is critical in increasing the quality of care and reducing costs for a group that accounts for high spending and the greatest risk for adverse outcomes. Healthcare systems are looking at ways to make high-need, high-costs patients a priority. A three-year pilot program that placed care coordinators in medical practices helped doctors care for high-needs patients and reduced health expenses.