Jonathan Stokes1, Vishalie Shah2, Leontine Goldzahl3, Søren Rud Kristensen4,5, Matt Sutton5. 1. Research Fellow, Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, UK. 2. Research Associate, Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, UK. 3. Associate Professor, EDHEC Business School, France. 4. Senior Lecturer, Faculty of Medicine, Institute of Global Health Innovation, Imperial College London, UK. 5. Associate Professor, Danish Centre for Health Economics Research, University of Southern Denmark, Denmark.
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.
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.
Entities:
Keywords:
integrated care; multimorbidity; new care models
Authors: Jonathan Stokes; Verena Struckmann; Søren Rud Kristensen; Sabine Fuchs; Ewout van Ginneken; Apostolos Tsiachristas; Maureen Rutten van Mölken; Matt Sutton Journal: Health Policy Date: 2018-07-11 Impact factor: 2.980
Authors: Jonathan Stokes; Mei-See Man; Bruce Guthrie; Stewart W Mercer; Chris Salisbury; Peter Bower Journal: Ann Fam Med Date: 2017-11 Impact factor: 5.166
Authors: Elizabeth A Stuart; Haiden A Huskamp; Kenneth Duckworth; Jeffrey Simmons; Zirui Song; Michael Chernew; Colleen L Barry Journal: Health Serv Outcomes Res Methodol Date: 2014-12-01
Authors: Peter Craig; Srinivasa Vittal Katikireddi; Alastair Leyland; Frank Popham Journal: Annu Rev Public Health Date: 2017-01-11 Impact factor: 21.981
Authors: Martin Roland; Richard Lewis; Adam Steventon; Gary Abel; John Adams; Martin Bardsley; Laura Brereton; Xavier Chitnis; Annalijn Conklin; Laura Staetsky; Sarah Tunkel; Tom Ling Journal: Int J Integr Care Date: 2012-07-24 Impact factor: 5.120
Authors: Susan Baxter; Maxine Johnson; Duncan Chambers; Anthea Sutton; Elizabeth Goyder; Andrew Booth Journal: BMC Health Serv Res Date: 2018-05-10 Impact factor: 2.655
Authors: Marcello Morciano; Katherine Checkland; Mary Alison Durand; Matt Sutton; Nicholas Mays Journal: BMC Health Serv Res Date: 2021-07-12 Impact factor: 2.655