Does prevention-focused integration lead to the triple aim? An evaluation of two new care models in England

Abstract

Objectives To examine the effectiveness of two integrated care models (‘vanguards’) in Salford and South Somerset in England, United Kingdom, in relation to patient experience, health outcomes and costs of care (the ‘triple aim’). Methods We used difference-in-differences analysis combined with propensity score weighting to compare the two care model sites with control (‘usual care’) areas in the rest of England. We estimated combined and separate annual effects in the three years following introduction of the new care model, using the national General Practice Patient Survey (GPPS) to measure patient experience (inter-organisational support with chronic condition management) and generic health status (EQ-5D); and hospital episode statistics (HES) data to measure total costs of secondary care. As secondary outcomes we measured proxies for improved prevention: cost per user of secondary care (severity); avoidable emergency admissions; and primary care utilisation. Results Both intervention sites showed an increase in total costs of secondary care (approximately £74 per registered patient per year in Salford, £45 in South Somerset) and cost per user of secondary care (£130–138 per person per year). There were no statistically significant effects on health status or patient experience of care. There was a more apparent short-term negative effect on measured outcomes in South Somerset, in terms of increased costs and avoidable emergency admissions, but these reduced over time. Conclusion New care models such as those implemented within the Vanguard programme in England might lead to unintended secondary care cost increases in the short to medium term. Cost increases appeared to be driven by average patient severity increases in hospital. Prevention-focused population health management models of integrated care, like previous more targeted models, do not immediately improve the health system’s triple aim.

The Effect of Integrated Care After Discharge From Hospitals on Outcomes Among Korean Older Adults

“…33 Previous studies on changes in costs due to integrated care in the community have shown inconsistent results. [34][35][36] This study revealed cost savings through the pilot project, which can be explained based on the results of length of home stay.…”

Impact of vertical integration on patients’ use of hospital services in England: an analysis of activity data

“…The study reported here followed earlier qualitative analysis by some of the same authors at two vertical integration locations in England and one in Wales. 6,7 A quantitative evaluation of new models of care integration at two locations by Stokes and colleagues, 24 includes one location that part way through the period studied also introduced vertical integration but analyses changes commencing at an earlier date and does not separately identify the impact of vertical integration.…”

Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

“…While recent initiatives have begun with a range of objectives including improving patient and carer experiences, policy and system objectives have tended to narrow over time leading to a strong emphasis on reductions in emergency admissions [15][16][17][18][19]. To date, however, there has been little evidence of initiatives successfully reducing emergency admissions [20][21][22][23][24][25][26]. One reason for the lack of evidence is that the initiatives are short-lived and often overlapping.…”