Study Evaluates Impact of Medical Home Features on Use of VA Healthcare and Total Costs of Care
In 2010, VA began a vast initiative to implement the medical home model, called Patient Aligned Care Teams (PACT), across the entire VA healthcare system. This longitudinal study evaluated changes in the adoption of different components of the PACT model in all VA primary care clinics and the relationship to patients' use of acute and non-acute care, as well as total costs after two years. Using VA data, investigators identified 2,607,902 Veterans who had at least two visits to any of 796 VA primary care clinics in FY09 – and also used any VA outpatient care in FY11. Data analyzed for this study included patient socio-demographics, VA inpatient and outpatient utilization, diagnoses, lab test results, and costs of all care, in addition to clinic characteristics and reporting of medical home features. Reporting of medical home features came from the American College of Physicians Medical Home BuilderÂ® (MHB) survey that was administered to all VA primary care clinics in 2009 and 2011. The MHB is self-administered and covers seven medical home components: 1) patient-centered care and communication; 2) access and scheduling; 3) care coordination and transitions in care (i.e., coordinating visits with other providers); 4) organization of practice (i.e., tracking procedures); 5) population management (i.e., clinical guidelines); 6) quality and performance improvements; and 7) use of technology (i.e., electronic health records).
- VA clinics reported large improvements in the adoption of all medical home components from FY09 to FY11. Improvements under the components 'organization of practice' and 'care coordination and transitions in care' appear to have impacted VA outpatient care (fewer primary care visits and more specialty care/fewer ED visits, respectively), but reductions in acute care were largely absent. Moreover, none of the changes in medical home components was significantly related to telephone visits, ACSC hospitalizations, or total health care costs.
- During the study period, the mean number of primary care visits decreased by 17%, while ED visits rose by 7%, and telephone visits rose by 85%.
- During the study period, the total costs of VA care increased from $8,469 to $9,887 per patient.
- Because the MHB was self-administered, investigators were unable to validate the adoption of reported medical home features.
- Reports of non-VA care were unavailable for this study, so if Veterans shifted to using more non-VA care, such as ED visits, investigators had no way of assessing this change.
Dr. Yoon is part of HSR&D's Center for Innovation to Implementation, Palo Alto, CA; Dr. Liu is part of HSR&D's Center for Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA; Drs. Rubenstein and Yano are part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA. Dr. Yano was supported by an HSR&D Senior Research Career Scientist Award.
Yoon J, Liu C-F, Lo J, Schectman G, Stark R, Rubenstein L, and Yano E. Early Changes in VHA Medical Home Components and Utilization. American Journal of Managed Care. March 2015;21(3):197-204.