Shawley Audrey, Sharma Sakshi, Jung Matthew, Lim John, Kavanagh Liam, Li Richard, Wadleigh Marshall, Nehmeh Amal, Denton G Dodd, Carstarphen Kathy Jo
The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA.
Department of Data Science, Ochsner Health System, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2024 Winter;24(4):248-261. doi: 10.31486/toj.24.0033.
Despite the substantial expenditures on health care in the United States, persistent underperformance in health system metrics necessitates innovative approaches to address complex patient needs. The MedVantage Clinic in New Orleans, Louisiana, offers a regionally tailored, value-based primary care model targeting patients with high social and medical needs. This study provides an evaluation of the efficacy of the MedVantage Clinic in improving the cost of care and service utilization for this population. We conducted a retrospective case-control study using data from electronic health records and claims data from 2017 to 2018. The case group was composed of patients with high social and medical needs who were enrolled in the MedVantage Clinic, and the control group consisted of propensity-matched non-MedVantage Clinic patients. Cost and utilization metrics-including per-member, per-month costs and inpatient length of stay-were analyzed using independent sample tests and difference-in-difference calculations. The MedVantage Clinic group demonstrated a significant decrease in mean inpatient per-member, per-month cost ($4.20) compared to an increase in the control group ($280.20, =0.017). Inpatient length of stay decreased by 1.7 days for MedVantage Clinic patients and increased by 8 days for control group patients (=0.019). Although other metrics showed nonsignificant improvements, the MedVantage Clinic generated a total cost of care mean resource benefit of $305.44 per member, per month compared to the control group (=0.112), with an estimated annual total benefit of $1,224,648 for 189 patients. Our findings highlight the potential of the MedVantage Clinic to improve health care costs and utilization for patients with high social and medical needs. Despite the limitations of the study, including study duration and patient selection biases, the MedVantage Clinic demonstrated promise as a scalable model for addressing complex patient needs. Further research is warranted to explore long-term outcomes and implementation strategies for similar models nationwide.
尽管美国在医疗保健方面投入了大量资金，但卫生系统指标持续不佳，这就需要创新方法来满足复杂的患者需求。路易斯安那州新奥尔良市的MedVantage诊所提供了一种针对当地情况、基于价值的初级保健模式，目标是社会和医疗需求较高的患者。本研究对MedVantage诊所在降低该人群医疗成本和提高服务利用率方面的效果进行了评估。我们利用2017年至2018年电子健康记录数据和理赔数据进行了一项回顾性病例对照研究。病例组由加入MedVantage诊所的社会和医疗需求较高的患者组成，对照组由倾向匹配的非MedVantage诊所患者组成。使用独立样本检验和差异分析计算来分析成本和利用率指标，包括人均每月成本和住院天数。与对照组人均每月住院成本增加（280.20美元，P=0.017）相比，MedVantage诊所组人均每月住院成本显著下降（4.20美元）。MedVantage诊所患者的住院天数减少了1.7天，而对照组患者增加了8天（P=0.019）。尽管其他指标显示改善不显著，但与对照组相比，MedVantage诊所每位成员每月产生的护理总成本平均资源效益为305.44美元（P=0.112），189名患者的估计年度总效益为1,224,648美元。我们的研究结果凸显了MedVantage诊所在降低社会和医疗需求较高患者的医疗成本及提高利用率方面的潜力。尽管该研究存在局限性，包括研究时长和患者选择偏差，但MedVantage诊所作为一种可扩展的模式来满足复杂患者需求展现出了前景。有必要进行进一步研究，以探索全国类似模式的长期结果和实施策略。
