Nav: Home

Integrated team-based care shows potential for improving health care quality, use and costs

August 23, 2016

Among adults enrolled in an integrated health care system, receipt of primary care at integrated team-based care practices compared with traditional practice management practices was associated with higher rates of some measures of quality of care, lower rates for some measures of acute care utilization, and lower actual payments received by the delivery system, according to a study appearing in the August 23/30 issue of JAMA.

Limited evidence is available to support the utility of medical home and accountable care integration with mental health and primary care teams. Brenda Reiss-Brennan, Ph.D., A.P.R.N., of Intermountain Healthcare, Salt Lake City, and colleagues assessed the association of integrating physical and mental health over time in team-based care (TBC) practices with patient outcomes and costs. The study included adult patients who received primary care at 113 Intermountain Healthcare Medical Group primary care practices from 2003 through 2005 and had yearly encounters with Intermountain Healthcare through 2013, including some patients who received care in both TBC and traditional practice management (TPM) practices.

Of the 113 practices observed over the study period (2010- 2013), 102 practices were classified annually as TBC (n = 27) or TPM (n = 75). The analysis included 113,452 patients (average age, 56 years; women, 59 percent). The researchers found that patients treated in TBC practices compared with those treated in TPM practices had higher rates of active depression screening (46 percent for TBC vs 24 percent for TPM), adherence to a diabetes care bundle (25 percent for TBC vs 20 percent for TPM), and documentation of self-care plans (48 percent for TBC vs 8.7 percent for TPM), lower proportion of patients with controlled hypertension (85 percent for TBC vs 98 percent for TPM), and no significant differences in documentation of advanced directives (9.6 percent for TBC vs 9.9 percent for TPM).

Rates of health care utilization were lower for TBC patients compared with TPM patients for emergency department visits, hospital admissions, ambulatory care sensitive visits and admissions, and primary care physician encounters, with no significant difference in visits to urgent care facilities and visits to specialty care physicians.

Payments to the delivery system were lower in the TBC group vs the TPM group ($3,401 for TBC vs $3,516 for TPM) and were less than investment costs of the TBC program.

"The study suggests the value of coordinated team relationships within a delivery system emphasizing the integration of physical and mental health care," the authors write.

(doi:10.1001/jama.2016.11232; the study is available pre-embargo to the media at the For the Media website)

Editor's Note: This research was supported by Intermountain Healthcare's Medical Group, Primary Care Clinical Program, Institute for Healthcare Leadership, Office of Research, and Office of Population Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

Editorial: Integrated Behavioral and Primary Care - What Is the Real Cost?

"This study has several important implications. Integrated TBC is clearly superior to TPM for patients with complex mental illness and chronic medical disease, consistent with the increasing recognition that this type of care is best applied to higher-risk patients with substantial disease burden," writes Thomas L. Schwenk, M.D., of the University of Nevada, Reno, in an accompanying editorial.

"However, practicing in an integrated, value- and outcomes¬ based model but continuing to be reimbursed in a traditional, volume-based system is costly. The investigators note that the investment cost of the program was lower than the reduction in reimbursement, but both are, in fact, a reduction in the bottom line for practices large and small, and therein lies the most important implication of this study."

"The results of the study by Reiss-Brennan et al document the value of an integrated model of mental health and chronic disease care that likely can only be provided to patients who receive their care in large, integrated health systems. The most significant consequence, however unintended, of outcomes-based medical care and value-based reimbursement may be a profound change in the fundamental structure of the U.S. health care delivery system."

(doi:10.1001/jama.2016.11031; the study is available pre-embargo to the media at the For the Media website)

Editor's Note: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

The JAMA Network Journals

Related Mental Health Articles:

Food insecurity can affect your mental health
Food insecurity (FI) affects nearly 795 million people worldwide. Although a complex phenomenon encompassing food availability, affordability, utilization, and even the social norms that define acceptable ways to acquire food, FI can affect people's health beyond its impact on nutrition.
Climate change's toll on mental health
When people think about climate change, they probably think first about its effects on the environment, and possibly on their physical health.
Quantifying nature's mental health benefits
The BioScience Talks podcast features discussions of topical issues related to the biological sciences.
Sexism may be harmful to men's mental health
Men who see themselves as playboys or as having power over women are more likely to have psychological problems than men who conform less to traditionally masculine norms, according to research published by the American Psychological Association.
Mental health matters
UCSB researchers study the effectiveness of an innovative program designed to help youth learn about mental health.
More Mental Health News and Mental Health Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#534 Bacteria are Coming for Your OJ
What makes breakfast, breakfast? Well, according to every movie and TV show we've ever seen, a big glass of orange juice is basically required. But our morning grapefruit might be in danger. Why? Citrus greening, a bacteria carried by a bug, has infected 90% of the citrus groves in Florida. It's coming for your OJ. We'll talk with University of Maryland plant virologist Anne Simon about ways to stop the citrus killer, and with science writer and journalist Maryn McKenna about why throwing antibiotics at the problem is probably not the solution. Related links: A Review of the Citrus Greening...