Research

Evidenced-Based Assessment of Economic Outcomes:
A Comparative Study

RELEASED MARCH 2019
This study demonstrates that employer-sponsored healthcare outside of fee-for-service is a viable solution to combat the high cost and inefficiencies of traditional transaction-based care, with significantly better outcomes for patients. Employees may have the opportunity to become more engaged, even highly engaged, in their personal health with convenient, low-cost access to a dedicated, collaborative, multi-disciplinary primary care team.

CLINICAL REVIEW SPONSORS
Hagg, Heather K., PhD;
Bravata, Dena, MD, MS;
Wright, John, MSc

This paper represents a summary of combined analyses from both peer-reviewed and third-party validated studies.

OBJECTIVE
To evaluate economic outcomes associated with patients managed by an on-site integrated health clinic through comparison against Community cohorts.

METHODOLOGY
Using retrospective cohort analyses, reviewers compared healthcare claims and Electronic Health Record data of Crossover highly engaged patients with Community managed patients for a minimum of 12 months of continuous enrollment within health plans. Crossover Highly Engaged and Community Utilizer cohorts were determined through attribution models.

STUDY RESULTS
As engagement in Crossover increases to >80%, the Average Annual Total Cost of Care decreases by up to 40%. The Highly Engaged Cohort has significantly fewer claims cost in high-cost referral areas, such as urgent care, specialty care and imaging. Patients seen at Crossover also have significant improvements in outcomes compared to the Community Utilizers.


Clinical Outcomes (Crossover v. Community)


ER/Urgent Care utilization reduced by ~20%; 45% fewer specialist visits;
40% fewer imaging studies


On average behavioral health patients were treated in 69% fewer visits, with significantly
improved outcomes for those with depression and/or anxiety (from moderate to mild levels)


On average for patients with musculoskeletal complaints,
equivalent or better outcomes are achieved in six less visits


On average, patients are prescribed less medicine, and non-cancer primary care patients
are prescribed opioids ~10X less frequently than the national average

ECONOMIC OUTCOMES
$2,194 average savings
on annual total cost of care per patient (up to 40% reduction)

IMPLICATIONS
This study demonstrates that employer-sponsored healthcare outside of fee-for-service is a viable solution to combat the high cost and inefficiencies of traditional transaction-based care, with significantly better outcomes for patients. Employees may have the opportunity to become more engaged, even highly engaged, in their personal health with convenient, low-cost access to a dedicated, collaborative, multi-disciplinary primary care team. An integrated model also allows for proactive program development across the health plan, as shown in these outcomes for physical medicine and behavioral health, with additional program analysis for women’s health and diabetes prevention and management under review in CY2019. Additionally, there are notably fewer referrals to Community specialists in an expanded primary health care model by controlling treatment of traditionally high-volume complaints, such as musculoskeletal and mental health, in-house.

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