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初级保健的连续性、频率和规律性与医疗保险储蓄有关。

Primary Care Continuity, Frequency, and Regularity Associated With Medicare Savings.

机构信息

University of Chicago Booth School of Business, Chicago, Illinois.

University of Chicago Medicine, Chicago, Illinois.

出版信息

JAMA Netw Open. 2023 Aug 1;6(8):e2329991. doi: 10.1001/jamanetworkopen.2023.29991.

DOI:10.1001/jamanetworkopen.2023.29991
PMID:37603335
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10442711/
Abstract

IMPORTANCE

Reducing Medicare expenditures is a key objective of Medicare's transition to value-based reimbursement models. Improving access to primary care is an important way to reduce expenditures, yet less is known about how visits should be organized to maximize savings.

OBJECTIVE

To examine the association between Medicare savings and primary care visit patterns.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from a 5% sample of traditional Medicare claims from 2016 to 2019. Participants had at least 3 primary care visits with at least 180 days between the first and the last visit, were not enrolled in Medicare Advantage, did not have end-stage kidney disease, and were not institutionalized. Data were analyzed from June 2022 to April 2023.

EXPOSURES

Primary care visit patterns: visit frequency, regularity, continuity of care.

MAIN OUTCOMES AND MEASURES

Savings in Medicare expenditures; risk-adjusted Medicare expenditures, number of emergency department (ED) visits, and hospitalizations.

RESULTS

Among 504 471 beneficiaries (298 422 [59.16%] women; mean [SD] age, 74.26 [10.41] years), temporally regular visits with higher continuity were associated with the highest savings. For these patients, the savings increased with increasing visit frequencies, with peak savings observed at higher visit frequencies as clinical complexity increased. As regularity and continuity decreased, the association between savings and visit frequencies progressively inverted. The group with a regular and highly continuous pattern was associated with greater savings (175.87%; 95% CI, 167.40% to 184.33%; P < .001), lower risk-adjusted expenditures (-16.61%; 95% CI, -16.73% to -16.48%; P < .001), fewer risk-adjusted ED visits (-40.49%; 95% CI, -40.55% to -40.43%; P < .001), and fewer risk-adjusted hospitalizations (-53.32%; 95% CI, -53.49% to -53.14%; P < .001) compared with the irregular noncontinuous group.

CONCLUSIONS AND RELEVANCE

In this cohort study, savings in Medicare expenditures and improvements in acute care utilization were associated with visit frequency, regularity, and continuity in primary care in an interrelated fashion such that optimization of primary care visit patterns along each axis were associated with the largest improvement in outcomes. Demonstrating the magnitude and interdependence of these associations is useful for health care professionals and policymakers as Medicare continues its transition to value-based reimbursement models.

摘要

重要性

降低医疗保险支出是医疗保险向基于价值的报销模式转变的关键目标。增加初级保健的可及性是降低支出的一个重要途径,但对于如何组织就诊以最大限度地节省费用,人们了解得还比较少。

目的

研究医疗保险储蓄与初级保健就诊模式之间的关系。

设计、设置和参与者:这项回顾性队列研究使用了 2016 年至 2019 年医疗保险传统索赔的 5%样本数据。参与者至少有 3 次初级保健就诊,且在第一次就诊和最后一次就诊之间至少间隔 180 天,没有参加医疗保险优势计划,没有终末期肾病,也没有住院治疗。数据分析于 2022 年 6 月至 2023 年 4 月进行。

暴露情况

初级保健就诊模式:就诊频率、规律性、连续性。

主要结果和措施

医疗保险支出的节省;风险调整后的医疗保险支出、急诊就诊次数和住院治疗次数。

结果

在 504471 名受益人中(298422 名[59.16%]为女性;平均[标准差]年龄为 74.26[10.41]岁),就诊时间有规律且连续性较高与最大节省相关。对于这些患者,随着就诊频率的增加,节省幅度增加,随着临床复杂性的增加,就诊频率越高,节省幅度越大。随着规律性和连续性的降低,节省与就诊频率之间的关联逐渐颠倒。就诊时间有规律且连续性高的患者组与更大的节省(175.87%;95%CI,167.40%至 184.33%;P<0.001)、较低的风险调整后医疗保险支出(-16.61%;95%CI,-16.73%至-16.48%;P<0.001)、较少的风险调整后急诊就诊次数(-40.49%;95%CI,-40.55%至-40.43%;P<0.001)和较少的风险调整后住院治疗次数(-53.32%;95%CI,-53.49%至-53.14%;P<0.001)有关,与不规则非连续性组相比。

结论和相关性

在这项队列研究中,医疗保险支出的节省和急性护理利用的改善与初级保健就诊的频率、规律性和连续性相关,这些方面的优化与结果的最大改善有关。展示这些关联的规模和相互依赖性对医疗保险在向基于价值的报销模式转变过程中的医疗保健专业人员和政策制定者很有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9c1/10442711/3fa316fc4de2/jamanetwopen-e2329991-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9c1/10442711/c0f8ea925b91/jamanetwopen-e2329991-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9c1/10442711/3fa316fc4de2/jamanetwopen-e2329991-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9c1/10442711/c0f8ea925b91/jamanetwopen-e2329991-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9c1/10442711/3fa316fc4de2/jamanetwopen-e2329991-g002.jpg

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