Examining how primary care clinics developed reductions in acute hospitalizations

Researchers from Mathematica studied high-performing Comprehensive Primary Care Plus (CPC+) sites to identify key strategies that contributed to significant reductions in acute hospitalization rates.

Researchers identified CPC+ practice sites with the highest likelihood of achieving substantial reductions in Medicare acute hospitalization rates between 2016 and 2018, and referred to them as "Acute Hospitalization Rate (AHR) high-performers." Afterwards, they conducted telephone interviews and within- and cross-case comparative analyses of 14 of these primary care practice sites, with the help of physicians, practice administrators, care managers, and other practice staff including nurses and pharmacists.

AHR high-performers credited various care delivery activities that aligned with three key strategies: (1) improving and promoting timely access to primary care, (2) identifying high-risk patients and providing enhanced care management tailored to their needs, and (3) expanding the range of services offered at the practice site.

The AHR high-performers also recognized several factors that facilitated the implementation of these strategies, such as receiving enhanced payments through CPC+, prior experience in transforming primary care practices, utilizing data to identify valuable activities for specific patient subgroups, fostering teamwork, and benefiting from organizational support for innovation.

Based on their findings, the researchers concluded that strengthening the local primary care infrastructure through practice-driven and targeted changes in access, care management, and comprehensiveness can support efforts to reduce incidence of acute hospitalizations. They encourage other primary care clinics to emulate these strategies, tailoring specific activities to fit their context, personnel, patient population and available resources.

What we know:

Access to timely primary care has been linked to reduced hospitalizations among patients. However, the existing health care system often lacks the necessary resources to enable primary care doctors to reach patients before their conditions worsen and require hospitalization. Notably, clinics enrolled in CMS' Comprehensive Primary Care Plus (CPC+) program receive both financial and technical support to proactively engage with patients prior to hospitalization.

However, researchers aren't certain what high-performing clinics are doing to reduce acute hospitalization rates. Petersen, et al's study strives to explain those specific activities.

What this study adds:

Clinics that successfully reduced acute hospitalization rates implemented several effective strategies. They focused on improving access to primary care, proactively identifying high-risk patients and providing them with enhanced care management. These clinics also expanded the range of services available to patients.

Additional contributing factors to their success included receiving enhanced payments through CPC+, prior experience with clinic transformations, utilizing data to identify high-value services for specific patient groups, receiving organizational support for change, and fostering teamwork among health care professionals.

The research is published in The Annals of Family Medicine journal.