UCSF Research: No Synergy From Valued-based Programs for Primary Care Organizations

Efforts to make primary care more efficient and centered on value-based care and positive outcomes for patients have failed to produce sizable synergistic effects, according to research published this week in JAMA Health Forum.

Julia Adler-Milstein

A research team led by Julia Adler-Milstein, Ph.D., a professor of medicine and director of the Center for Clinical Informatics and Improvement Research at the University of California, San Francisco, looked at the effects of participation in CMS’ meaningful use program, the National Committee for Quality Assurance’s patient-center medical home program and the Medicare Shared Savings Program (MSSP) ACOs. More specifically, they looked at whether participation in programs had positive effects on avoidable hospitalizations, adherence to evidence-based guidelines, and spending.

The complicated research, which involved assessing the programs individually and in various combinations, showed that participation in all three programs was associated with a modest increase in adherence to diabetes guidelines and spending on acute care, but that was also true of participation in a single program.

“Collectively these findings suggest that there is no systematic program synergy, at least not with the outcomes examined, “ wrote Adler-Milstein and her colleagues.

The data they looked was from nearly 48,000 primary care organizations, and the outcomes were for 2009, 2010 and 2015-2017.

Participation in the meaningful use program was the highest: 23.5% of the primary care organizations participated for one to two years and an additional 37%, for three to six years.

But only 1.4% of the primary care organizations participated in the patient-centered medical home program for three to six years.

The researchers noted that a large proportion of the primary care organizations avoided signing up for the programs altogether: 39.7% did not participate in the meaningful use program, 78.3% did not participate in the MSSP ACO program and 97.4% did not participate in the patient-centered medical home program.

The programs examined in the study were not entirely ineffective. For example, participation in the MSSP ACO program, by itself or in tandem with the meaningful use program, led to some reduction in Medicare spending. The reduction was qu8tesmall, though. The organizations that were in both the MSSP and meaningful programs reduced spending produced savings of just 0.51% ($33.89 lower spending per beneficiary per year).

The patient-centered medical home program was the most effective program when it came to adherence to diabetes guidelines.

Overall, the researchers said their findings should prompt policymakers to consider how programs aiming to transform primary care could be better aligned. They said the separation of technology efforts and from those targeting improvement processes need to be addressed.

“Without more explicit efforts to synchronize EHR (electronic health record) capabilities with activities needed to deliver high-quality, low-cost primary care, it will be difficult for PCOs (primary care organizations) to realize substantial benefits from multiprogram participation,” they wrote.