Patient-centered care found to reduce medical costs
■ When patients play a more active role in their health, costly and unnecessary tests can be eliminated, a study says.
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Patient-centered care, already determined to be beneficial in improving the nation's health, also can help lower medical costs and reduce the need for some health care services, research by the University of California, Davis, Health System shows.
When physicians have more personalized discussions with their patients and encourage them to take a more active role in their health, both doctor and patient have more confidence that they reached a correct diagnosis and a good strategy to improve the patient's health. That approach can help eliminate or reduce unnecessary and costly testing and referrals to specialists, said the study in the May/June issue of the Journal of the American Board of Family Medicine (link).
"Our study shows that including patients in more of the treatment and care-planning discussion is not only the right thing to do, it is also cost effective," said family physician Klea Bertakis, MD, MPH, principal investigator of the study and professor and chair of the UC Davis, Dept. of Family and Community Medicine. She said the research needs to be followed by a long-range study, perhaps as long as 15 years.
The findings did not surprise doctors who already focus on patient-centered care.
"Future studies will reinforce this type of result," said family physician E. Christopher Bush, MD, of Riverview, Mich. "Patient-centered medical homes will be good for all populations." Dr. Bush is entering his fourth year as a designated patient-centered medical home physician by Blue Cross Blue Shield of Michigan.
David Meyers, MD, director of the Center for Primary Care, Prevention and Clinical Partnerships at the Agency for Healthcare Research and Quality, said while the study found an association between patient-centered care and costs and utilization, "its design does not allow us to conclude that patient-centered care directly leads to cost savings."
"Patient-centered care is a central dimension of quality in and of itself. This study adds to our knowledge that it also may have an impact on other dimensions of quality -- in this case, efficiency," he said.
Patient-centered care has been gaining interest in both the medical and insurance fields. The Institute of Medicine has identified the concept as one of the keys to improving the nation's health. Some insurers, such as the Michigan Blues, have started rewarding doctors who follow key components, which include extended access, electronic prescribing and patient registry to track patients.
In the UC Davis study, more than 500 randomly chosen patients were followed for one year. They received care by family physicians and internists.
"All of the patients chosen were new patients at our clinics, which gave us an advantage over other studies done on patient-centered care where there was already an established doctor-patient relationship," Dr. Bertakis said.
Each examination was videotaped, analyzed and coded to measure the extent of discussions between patients and physicians. Factors indicative of patient-centered care included discussions of family and social histories, nutrition and exercise, the patient's beliefs about his or her health, and counseling on the patient's emotions and interpersonal relationships. The factors were compared with the patient's number of health care visits and charges throughout the year.
The study found the number of specialty-care visits, hospitalizations and diagnostic services were significantly reduced, as were total health care and specialty-care charges, among patients who received more patient-centered care.
"If [a family physician] has done a good job of explaining what's going on with a patient, given a good diagnosis and treatment plan, you don't need to engage a specialist," said Dr. Bush, president-elect of the Michigan Academy of Family Physicians.
Rose Ramirez, MD, a family physician in Grand Rapids, Mich., who works at a Blues-designated patient-centered medical home, believes the practice of the future will feature a physician's team that spends more time with patients and has more meaningful discussions.
"When you have a long-term relationship, patients develop trust," she said. "If I don't think a patient needs a surgical procedure, I can give the patient a list of choices, all at a cost savings."