Productivity enhancement for primary care providers using multicondition care management.
OBJECTIVE
To assess the impact of a multicondition care management system on primary care physician efficiency and productivity.


METHODS
Retrospective controlled repeated-measures design comparing physician productivity with the proportion of patients in the care management system.


METHODS
The setting was primary care clinics in Intermountain Healthcare, a large integrated delivery network. The care management system consisted of a trained team with nurses as care managers and specialized information technology. We defined the use of the care management system as a proportion of referrals by the physician to the care manager. Clinic, physician, and patient panel demographics were used to adjust expected visit productivity and were included in a multivariate mixed model with repeated measures comprising work relative value units and system use.


RESULTS
The productivity of 120 physicians in 7 intervention clinics and 14 control clinics was compared during 24 months. Clinic, physician, and patient panel characteristics exhibited similar characteristics, although patients in intervention clinics were less likely to be married. Adjusted work relative value units were 8% (range, 5%-12%) higher for intervention clinics vs control clinics. Additional annual revenue was estimated at 99,986 dollars per clinic. These additional revenues outweighed the estimated cost of the program of 92,077 dollars.


CONCLUSIONS
Physician productivity increased when more than 2% of patients were seen by a care management team; the increased revenue in our market exceeded the cost of the program. Implications for the creation, structure, and reimbursement of such teams are discussed.
Dorr
David A
DA
Department of Medical Informatics, Oregon Health & Science University, Mailcode BICC, Portland, OR 97239, USA. dorrd@ohsu.edu
Wilcox
Adam
A
McConnell
K John
KJ
Burns
Laurie
L
Brunker
Cherie P
CP
D000328:Adult; D000704:Analysis of Variance; D019090:Case Management; D003362:Cost-Benefit Analysis; D004526:Efficiency; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D007061:Idaho; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015895:Relative Value Scales; D012189:Retrospective Studies; D014589:Utah