title: Outcomes For High-Needs Patients: Practices With A Higher Proportion Of These Patients Have An Edge.
abstract: High-value primary care for high-needs patients-those with multiple physical, mental, or behavioral health conditions-is critical to improving health system performance. However, little is known about what types of physician practices perform best for high-needs patients. We examined two scale-related characteristics that could predict how well physician practices delivered care to this population: the proportion of patients in the practice that were high-needs and practice size (number of physicians). Using four years of data on commercially insured, high-needs patients in Michigan primary care practices, we found lower spending and utilization among practices with a higher proportion of high-needs patients (more than 10 percent of the practice's panel) compared to practices with smaller proportions. Small practices (those with one or two physicians) had lower overall spending, but not less utilization, compared to large practices. However, practices with a substantial proportion of high-needs patients, as well as small practices, performed slightly worse on a composite measure of process quality than their associated reference group. Practices that treat a high proportion of high-needs patients might have structural advantages or have developed specialized approaches to serve this population. If so, this raises questions about how best to make use of this knowledge to foster high-value care for high-needs patients.
authors.affiliation: Dori A. Cross (dacross@umich.edu) is a doctoral candidate in the Department of Health Management and Policy, School of Public Health, University of Michigan, in Ann Arbor.
authors.forename: Dori A
authors.initials: DA
authors.lastname: Cross
authors.affiliation: Genna R. Cohen is a researcher at Mathematica Policy Research in Washington, D.C.
authors.forename: Genna R
authors.initials: GR
authors.lastname: Cohen
authors.affiliation: Christy Harris Lemak is chair of and a professor in the Department of Health Services Administration at the University of Alabama at Birmingham.
authors.forename: Christy Harris
authors.initials: CH
authors.lastname: Lemak
authors.affiliation: Julia Adler-Milstein is an associate professor of information in the School of Information and an associate professor of health management and policy in the Department of Health Management and Policy, School of Public Health, both at the University of Michigan.
authors.forename: Julia
authors.initials: J
authors.lastname: Adler-Milstein
mesh_terms: D002908:Chronic Disease; D005260:Female; D006123:Group Practice / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care
keywords: Chronic Care; Organization and Delivery of Care; Primary Care; Quality Of Care