Contribution of the Transforming Clinical Practice Initiative in Advancing the Movement to Value-Based Care

Abraham, Meena R.; McGann, Paul

doi:10.1370/afm.2425

Cited by 8 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Payers around the country are testing the patient-centered medical home (PCMH) and similar models and increasingly paying for health care through alternative payment models that reward quality and value. [1][2][3][4][5][6][7][8][9][10] Researchers and practitioners have warned that it takes time to transform care and shift patient outcomes, 1,[11][12][13] but there have been no long-term models (running for greater than five years) to assess whether the generally minimal changes that have been documented in outcomes such as emergency department visits and hospitalizations 1 actually improve with longer interventions. Against this backdrop, it is important to understand how longer tests of these models affect health care spending and utilization.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Effects of the Comprehensive Primary Care Model on Health Care Spending and Utilization

Singh

Dale

et al. 2021

J GEN INTERN MED

View full text Add to dashboard Cite

BACKGROUND:The Centers for Medicare & Medicaid Services launched the 4-year Comprehensive Primary Care Initiative (CPC Classic) in 2012 and its 5-year successor, CPC Plus (CPC+), in 2017 to test whether improving primary care delivery in five areas-and providing practices with financial and technical support-reduced spending and improved quality. This is the first study to examine long-term effects of a primary care practice transformation model. OBJECTIVE: To test whether long-term primary care transformation-the 4-year CPC Classic and the first 2 years of its successor, CPC+-reduced hospitalizations, emergency department (ED) visits, and spending over 6 years. DESIGN: We used a difference-in-differences analysis to compare outcomes for beneficiaries attributed to CPC Classic practices with outcomes for beneficiaries attributed to comparison practices during the year before and 6 years after CPC Classic began. PARTICIPANTS: The study involved 565,674 Medicare fee-for-service beneficiaries attributed to 502 CPC Classic practices and 1,165,284 beneficiaries attributed to 908 comparison practices, with similar beneficiary-, practice-, and market-level characteristics as the CPC Classic practices. INTERVENTIONS:The interventions required primary care practices to improve 5 care areas and supported their transformation with substantially enhanced payment, data feedback, and learning support and, for CPC+, added health information technology support. MAIN MEASURES: Hospitalizations (all-cause), ED visits (outpatient and total), and Medicare Part A and B expenditures. KEY RESULTS: Relative to comparison practices, beneficiaries in intervention practices experienced slower growth in hospitalizations-3.1% less in year 5 and 3.5% less in year 6 (P < 0.01) and roughly 2% (P < 0.1) slower growth each year in total ED visits during years 3 through 6. Medicare Part A and B expenditures (excluding care management fees) did not change appreciably. CONCLUSIONS: The emergence of favorable effects on hospitalizations in years 5 and 6 suggests primary care transformation takes time to translate into lower hospitalizations. Longer tests of models are needed.

show abstract

Section: Introductionmentioning

confidence: 99%

Long-Term Effects of the Comprehensive Primary Care Model on Health Care Spending and Utilization

Singh

Dale

et al. 2021

J GEN INTERN MED

View full text Add to dashboard Cite

show abstract

“…Adding to the emerging evidence base of TCPI’s impact on practice transformation,9 our findings suggest that the initiative had yet to demonstrate its impact on cost and utilization measures halfway through the intervention. Although the assistance of TCPI included supporting practices in reducing costs,18 the differential effect of such effort was not substantiated in our sample of family medicine–based practices.…”

Section: Discussionmentioning

confidence: 85%

“…For the non-PTN sample, we started with 30,017 practices that met the same inclusion criteria in 2011. We used propensity score matching to select up to 5 non-PTN practices per PTN practice that were homogeneous in the patient (eg, percentage of patients with diabetes), practice [eg, practice size-solo, small (2-5), medium (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), large ( > 20)], and area characteristics (eg, number of primary care physicians per 100,000 population at the county level) in 2011, but were not enrolled in a PTN in 2016. Propensity score matching has been used commonly as an effective approach to address selection bias in nonexperimental evaluations.…”

Section: Samplementioning

confidence: 99%

Family Practices in Transforming Clinical Practice Initiative Showed No Changes in Medicare Costs or Utilization

et al. 2021

View full text Add to dashboard Cite

Background: The Centers for Medicare and Medicaid Services proposed that the Transforming Clinical Practice Initiative (TCPI) would improve health outcomes for patients, reduce utilization of institutional services, and generate significant savings for payers by the end of September 2019. Objective:The objective of this study was to investigate whether participation in TCPI's Practice Transformation Networks (PTNs) was associated with improved cost and utilization outcomes for Medicare patients of family medicine-based practices in the first 2 years, that is, 2016-2017, of the Initiative.Study Design: A quasi-experimental design with a longitudinal cohort of family medicine-based practices and a propensity-matched comparison sample.Subjects: A total of 761 PTN practices and 3451 non-PTN practices. Measures:To measure practice-level patient outcomes, we attributed patients to practice based on the plurality of office visits. We obtained Medicare claims from 2011 to 2017 to assess PTN participation effects for Medicare Part A and B costs, hospital admission, and emergency department visit rates using a Difference-in-Differences design, adjusting for baseline characteristics.Results: The differences in Medicare Part A and B costs (−1.71%, P = 0.25), annual rates of hospitalization (−0.59%, P = 0.12) and emergency department visit (−0.29%, P = 0.46) were not significantly lower among PTN practices (N = 761) than among propensity score-matched non-PTN practices (N = 3541).Conclusions: TCPI's transforming efforts, such as the outcomes examined in the study, might need a longer time frame to manifest and require evaluation after the full 4-year participation period. The indistinguishable effect of PTN participation may also be attributed to the fact that non-PTN practices might have participated in other initiatives that changed their care and curbed health care utilization and costs consequently.

show abstract

“…1 , 2 Managed care organizations (MCOs) work to control the cost of healthcare services while maintaining high-quality patient care. To achieve the goal of “better care and better outcomes at lower cost,” continued efforts are needed to move healthcare delivery systems, such as MCOs, to fully embrace value-based care models that focus on “providing the right care at the right time at reasonable costs.” 3 However, to accomplish this requires that clinicians make fundamental changes to their daily practices, which is challenging at best without the necessary supports in place. 4…”

Section: Introductionmentioning

confidence: 99%

Pilot Testing a Series of Value-Based Care Training Courses

Kovach¹,

Obanua²,

Hutchins³

2022

AMEP

View full text Add to dashboard Cite

Purpose The US healthcare system currently emphasizes volume of services over value. To facilitate changing to a value-based care model, one managed care organization developed a series of online courses designed to teach clinicians value-based care principles and practices. A pilot test was conducted to obtain feedback regarding course content and design, so the courses could be revised prior to their launch. Patients and Methods A representative cross section of the courses’ target audience (n = 50) was recruited to participate in the pilot test, and data were collected through an online survey. Descriptive statistics were calculated for responses to close-ended survey questions, and affinity analysis was performed on responses to open-ended survey questions. Issues identified were then categorized as urgent/not urgent with respect to course revision. Results Nearly a quarter (24%) of respondents indicated that the course contained incorrect or misleading information. Other responses noted inconsistencies in course content, eg, misspelled or mispronounced words, slides that were hard to read, etc. Conclusion This study demonstrates how a pilot test was used as part of a formative assessment to improve course content and design. During a pilot test, attention should be paid to making it easy for participants to provide feedback.

show abstract

Contribution of the Transforming Clinical Practice Initiative in Advancing the Movement to Value-Based Care

Cited by 8 publications

References 0 publications

Long-Term Effects of the Comprehensive Primary Care Model on Health Care Spending and Utilization

Long-Term Effects of the Comprehensive Primary Care Model on Health Care Spending and Utilization

Family Practices in Transforming Clinical Practice Initiative Showed No Changes in Medicare Costs or Utilization

Pilot Testing a Series of Value-Based Care Training Courses

Contact Info

Product

Resources

About