UAMS study finds savings in Blue Cross patient-centered medical homes

Two patient-centered medical home programs involving Arkansas Blue Cross and Blue Shield beneficiaries generated savings of $80 per person per quarter by the end of the fourth year, a study found.

Researchers with the University of Arkansas for Medical Sciences compared spending and health care utilization in three patient-centered medical home payment models, where a single medical practice coordinates care for patients and is paid a monthly care management fee.

The coordinated care can involve follow-up calls by a nurse manager to help patients follow their treatment plans, after-hours access to care teams, and increased use of information technology. The practice can benefit financially from savings and/or performance-based incentive payments.

The study found that the savings increased over time. In the two programs that had four years of data, the return on investment rose to $5.84 for every dollar spent on care management fees.

The findings were published in an issue brief, “Value-Based Primary Care: Insights from a Commercial Insurer in Arkansas.” It was written by Clare Brown, Ph.D., MPH; and J. Mick Tilford, Ph.D., who are health policy and management professors at the UAMS Fay W. Boozman College of Public Health. The study was supported by the Milbank Memorial Fund.

The report notes that the Centers for Medicare and Medicaid Services has estimated that health care will consume 19.4% of U.S. gross domestic product by 2028. The agency’s Center for Medicare and Medicaid Innovation has tested several cost savings models through its Comprehensive Primary Care (CPC) program.

Those include the CPC Classic initiative, a four-year program that began in October 2012 and involved four states including Arkansas and three other regions, including the Greater Tulsa region. In Arkansas, the program involved 58 primary care practices and 230 providers and served 337,660 patients. Participating payers included Blue Cross, Arkansas Medicaid, Humana and QualChoice of Arkansas.

The researchers found that average beneficiary spending for Arkansas participants in the CPC Classic program decreased $81.78 by the fourth year compared to practices that did not participate. Costs increased by $8.31 during the first year in 2013 and then decreased $29.81 in 2014, $37.99 in 2015, and $81.78 in 2016. The average cost decrease over that time period was $34.27.

Blue Cross created its own Arkansas Blue Cross Patient Centered Medical Home Program. There, average beneficiary spending increased by $14.13 during the program’s first year in 2015 and then decreased $12.91 in 2016, $40.31 in 2017, and $79.62 in 2018 compared to practices that did not participate. The average cost decrease over that time period was $31.67.

The researchers wrote it can take 18 months to three years to see the benefits of medical home programs, but then savings can increase over time.

The researchers found the return on investment increased by the end of the study to $5.84 for every dollar spent on care management fees in both the CPC Classic and Blue Cross models. Over the course of the study, participants in the CPC Classic program saved an average of $2.53 for every dollar spent on care management fees, while the Blue Cross program saved $2.22. Like the savings, the return on investment increased over time.

The researchers suggest that reduced acute care and emergency department spending could be primary drivers of the cost reductions. In the CPC Classic program, acute care spending decreased $13.14 in participating practices, while emergency department spending decreased $4.52. Researchers found a .1% reduction in the probability of an acute care visit in the CPC Classic program and a .9% reduction in the probability of an emergency department visit.

The CPC Classic program served as a template for Comprehensive Primary Care Plus, a five-year program occurring in 18 regions, including the CPC Classic’s original seven. In Arkansas, 181 practices are participating. Average beneficiary spending increased by $17.93 per person per quarter the first year in 2017 and then fell $33.43 in 2018. That program is ongoing.

The study also found average savings of $35.37 per person per quarter for practices that participated in the CPC Classic program and also in the first two years of CPC+. By 2018, those practices were saving $79.35 per beneficiary per quarter.

The researchers wrote that Arkansas’ results perhaps cannot be generalized to other programs because of the statewide participation in the programs here. The widespread scope may improve the ability to provide value-based care. Also, providers were not randomly selected. CMS approved the participating practices in the CPC Classic program, while Blue Cross approved the practices in its program. Previous studies have found some populations may benefit differently than others.

The report notes that Arkansas Blue Cross since 2015 has allowed beneficiaries to select their own medical home, which may contribute to the program’s success. The insurer also provides assistance to participating providers.

The study was completed with contributions from Blue Cross employees Alicia Berkemeyer, senior vice president of provider network programs; Victor Davis, chief actuary and vice president of actuarial and underwriting; and Adam Whitlock, manager of primary care.