A team of researchers has done a regression-adjusted data analysis that finds that senior-focused primary care patients are receiving more primary care visits than others. Writing in the September issue of Health Affairs, Kaylyn E. Swankoski, Amanda Sutherland, Emily Boudreau, Yong Li, Melanie Canterberry, J. Michael McWilliams, Vevk Garg, and Brian W. Powers lay out the case that primary care focused on seniors improves outcomes.
Their article, “Senior-Focused Primary Care Organizations Increase Access For Medicare Advantage Members, Especially Underserved Groups,” looks at some of the complexities surrounding care management for underserved groups in Medicare Advantage plans. The authors state that “Population-based payment in Medicare Advantage (MA) can foster innovation in care delivery by giving risk-bearing providers flexibility and strong incentives to enhance care and engage patients. This may particularly benefit historically underserved groups for whom payments often exceed costs. In this study, using data from Humana MA plans, we examined ‘senior-focused’ primary care organizations that are supported predominantly by population-based payments in contracts with MA plans. We explored whether such organizations supported by such payment are associated with better care and improved equity compared with other primary care organizations receiving other forms of payment in MA.”
And what they found was that “senior-focused primary care patients received 17 percent more primary care visits. Differences were largest among Black and dual-eligible beneficiaries. These findings suggest that risk-bearing organizations in MA are responding to current payment dynamics and providing enhanced care and access to patients, particularly historically underserved populations,” they note.
They do caution that there is complexity in their findings. “Although we cannot confidently conclude that senior-focused primary care organizations lowered acute care use, we note that they potential differences in hospitalizations and ED visits were more consistently sizable than the mostly modest and inconsistent differences in performance on quality measures, particularly when the analysis was limited to providers in two-sided risk arrangements. This suggests that any reductions in acute care use by senior-focused primary care may have been mediated less by better disease control and more by substituting primary care for acute care (for example, redirecting patients from the ED to the clinic) or by reducing unnecessary and wasteful admissions directly.”
And, the authors conclude, “Taken together, our findings provide additional evidence on the scope and impact of payment reform in the Medicare program. The senior-focused primary care organizations included in this analysis are largely new, for-profit entrants that emerged in response to the growth of population-based payment arrangements in MA. That these organizations appear to be delivering differentiated care and outcomes suggests that population-based payment reform might be an effective mechanism not only to change the existing delivery system but also to catalyze the development and grown of new organizations and care models.”
