Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore

Abstract

Introduction: The Patient-Centred Medical Home (PCMH) demonstration in Singapore, launched in November 2016, aimed to deliver integrated and patient-centred care for patients with biopsychosocial needs. Implementation was based on principles of comprehensiveness, coordinated care and shared decision-making. Method: We conducted a prospective single-arm pre-post study design, which aimed to perform cost analysis of PCMH from the perspectives of patients, healthcare providers and society. We assessed short-to-intermediate-term health-related costs by analysing data on resource use and unit costs of resources. Results: We analysed 165 participants enrolled in PCMH from November 2017 to April 2020, with mean age of 77 years. Compared to the 3-month period before enrolment, mean total direct and indirect participant costs and total health system costs increased, but these were not statistically significant. There was a significant decrease in mean cost for primary care (government primary care and private general practice) in the first 3-month and second 3-month periods after enrolment, accompanied by a significant decrease in service utilisation and mean costs for PCMH services in the second 3-month period post-enrolment. This suggested a shift in resource costs from primary care to community-based care provided by PCMH, which had added benefits of both clinic-based primary care and home-based care management. Findings were consistent with a lower longer-term cost trajectory for PCMH after the initial onboarding period. Indirect caregiving costs remained stable. Conclusion: The PCMH care model was associated with reduced costs to the health system and patients for usual primary care, and did not significantly change societal costs. Keywords: Aged, economic evaluation, health financing, patient-centred care

An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore

“…This study was part of the programme evaluation of an integrated PCMH model of care in Singapore that involved quantitative and qualitative research components [22,23,25]. We applied a quasi-experimental design for this study, whereby the intervention group consisted of study participants enrolled in the integrated PCMH and the comparator group was matched controls.…”

“…Study participants in the intervention group were recruited from 1 November 2017 to 30 April 2019. Eligibility criteria were as follows: [22,23].…”

“…The integrated PCMH care model in this study was a component of the Community for Successful Ageing (ComSA) initiative in Singapore, an integrated care network of community-based programmes and services that delivered comprehensive and coordinated care to older adults [22,23]. The integrated PCMH model was guided by four tenets, including the life-course approach to deliver timely intervention for prevention and management of needs, ageing in place, the socioecological model of care, and population health management [22][23][24].…”

“…The integrated PCMH care model in this study was a component of the Community for Successful Ageing (ComSA) initiative in Singapore, an integrated care network of community-based programmes and services that delivered comprehensive and coordinated care to older adults [22,23]. The integrated PCMH model was guided by four tenets, including the life-course approach to deliver timely intervention for prevention and management of needs, ageing in place, the socioecological model of care, and population health management [22][23][24]. Our integrated PCMH intervention aimed to differentiate from existing primary care models in Singapore by targeting community-dwelling older adults with a combination of physical, psychological, and social care needs and delivering primary care and home-based care intervention elements.…”

“…Our integrated PCMH intervention aimed to differentiate from existing primary care models in Singapore by targeting community-dwelling older adults with a combination of physical, psychological, and social care needs and delivering primary care and home-based care intervention elements. Current primary care models have focused on chronic disease management by multidisciplinary teams (teamlet care models) or by general practitioners at family medicine clinics [22,23].…”