How personalized preventative care reduces Medicare spending
By - A primary care model that focuses on personalized preventive medicine can reduce Medicare Advantage spending, according to a recent report published in the American Journal of Managed Care (AJMC).
Researchers studied costs within the MD-Value in Prevention (MDVIP), a network comprising primary care physicians who utilize a model of healthcare delivery based on an augmented physician-patient relationship and are focused on personalized preventive healthcare. Additionally, the MDVIP model limits practices to no more than 600 patients per physician.
MDVIP currently includes over 600 doctors and over 200,000 patients nationally. Affiliated physicians have an average age of 58 years, while the average age of members is 66 years. Lastly, 40 percent to 45 percent are enrolled in Medicare plans.
The study included 2,360 members and 5,521 nonmembers.
“Personalized medicine is a relatively new healthcare delivery model designed to provide more individualized care focused on disease prevention while delivering high-quality, coordinated care with easy access,” researchers wrote in the report. “The MDVIP program is based on an augmented physician-patient relationship and focused on personalized preventive care. This study investigated the impact of an enhanced preventive care delivery system on healthcare expenditure and utilization trends among Medicare Advantage beneficiaries.”
The study found that MDVIP members saw greatly reduced utilization rates for emergency department visits and inpatient admissions. Specifically, the reduced medical utilization turned out program savings of $86.68 per member per month (PMPM) in the first year and $47.03 PMPM in the second year compared to nonmembers.
“This current study is one of the first to demonstrate the cost-effectiveness of a personalized preventive care model within a Medicare population,” researchers explained. “The feasibility of this model of healthcare delivery in other Medicare populations (e.g., fee-for-service) has yet to be determined.”
Typically, the Centers for Medicare & Medicaid Services (CMS) have focused on high-risk and high-cost Medicare patients, driven the belief that the current disease and case management programs are the best option to reduce hospitalizations. However, researchers explained that this is true for only a subset of very sick patients (generally those with at least one hospitalization within the year before enrolling in the programs).
The study further shows the importance of mitigating spending earlier, researchers explained. Managing risk across an entire population requires two approaches: high-risk subgroups need programs, but there must also be programs available to healthy beneficiaries who are managing their health as they age.
“Without attention to disease prevention and wellness, the migration of individuals to higher risk categories will continue as they age (i.e., a natural progression of aging and disease), especially as Americans continue to live longer,” researchers wrote. “Therefore, slowing down the upward transitions must be a priority if population health management is to be successful in this population.”
Researchers did acknowledge that their study consisted of a small population with individuals who were enrolled in a Medicare Advantage program through a single insurer. However, the study still had its strengths. For example, the research accounted for differences in physicians’ medical delivery styles and quality by an evaluation of utilizing former patients of affiliated physicians. Additionally, the study “used multivariate models to adjust for case mix differences between those in the program and comparison members.”
