New Payment Models Needed For Financial Viability of Team-Based Care

Implementation of a team-based care system in a primary care practice for managing patients with coronary heart disease (CHD) improved patient outcomes but had a negative financial impact on primary care under a fee-for-service (FFS) payment model. 

This is the main finding of a study that looked at the impact of team-based care for CHD patients on utilization, costs, and revenue of a private primary care practice.  The study was conducted to test the hypothesis that implementation of a team-based care system for patients with CHD, who are at much higher risk of another cardiac event in the near term, would be revenue-neutral or revenue-positive for primary care.

To test this hypothesis, investigators helped a private medical practice comprised of five primary care clinic sites to implement team-based care for their patients with CHD between March 1, 2010 and March 31, 2013. A registered nurse care manager coordinated the team-based care.

The intervention was geared to improving low-density lipoprotein cholesterol (LDL-C) control and increasing the rate at which aspirin intake is documented.

The team-based system did improve LDL-C control and increased the rate at which aspirin use was documented. However, the study did not show that the team-based system was revenue-neutral or revenue-positive for the primary care clinics in the study.

The study found that it cost $291 per patient over one year to treat patients with CHD using the team-based care system. Although the revenue per clinic visit increased (5.7%), the net effect of the team-based care system was a reduction in revenues earned per patient (-2.5%). This was because of a reduction in the number of clinic visits (-4.3%) under the team-based system. 

Although the study did not find the team-based system to be revenue-neutral or revenue-positive for primary care as hypothesized, the investigators suggest that the a potential cost savings to primary care by using a team-based system for CHD patients may be possible under a different type of payment model.

“Team-based care for patients with CHD has the potential to be cost-saving for accountable care organizations if team-based care reduces overall costs by as little as 2%,” the authors wrote.

The current study shows, however, that primary care practices operating under the traditional FFS payment model bear all the costs and none of the savings from team-based care.

“This suggests that primary care practices will not adopt team-based care and their patients will not experience the benefits until new payment models are developed and implemented,” the researchers wrote. —Mary Beth Nierengarten