• Evelyn T Chang, Alexis Huynh, Caroline Yoo, Jean Yoon, Donna M Zulman, Michael K Ong, Melissa Klein, Jessica Eng, Sudip Roy, Susan E Stockdale, Elvira E Jimenez, Angela Denietolis, Jack Needleman, Steven M Asch, and PACT Intensive Management (PIM) Demonstration Sites, PIM National Evaluation Center, and PIM Executive Committee.
• VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA. Evelyn.Chang@va.gov.
• J Gen Intern Med. 2024 Jul 29.

BackgroundMany healthcare systems have implemented intensive outpatient primary care programs with the hopes of reducing healthcare costs.ObjectiveThe Veterans Health Administration (VHA) piloted primary care intensive management (PIM) for patients at high risk for hospitalization or death, or "high-risk." We evaluated whether a referral model would decrease high-risk patient costs.DesignRetrospective cohort study using a quasi-experimental design comparing 456 high-risk patients referred to PIM from October 2017 to September 2018 to 415 high-risk patients matched on propensity score.ParticipantsVeterans in the top 10th percentile of risk for 90-day hospitalization or death and recent hospitalization or emergency department (ED) visit.InterventionPIM consisted of interdisciplinary teams that performed comprehensive assessments, intensive case management, and care coordination services.Main Outcomes And MeasuresChange in VHA and non-VHA outpatient utilization, inpatient admissions, and costs 12 months pre- and post-index date.Key ResultsOf the 456 patients referred to PIM, 301 (66%) enrolled. High-risk patients referred to PIM had a marginal reduction in ED visits (- 0.7; [95% CI - 1.50 to 0.08]; p = 0.08) compared to propensity-matched high-risk patients; overall outpatient costs were similar. High-risk patients referred to PIM had similar number of medical/surgical hospitalizations (- 0.2; [95% CI, - 0.6 to 0.16]; p = 0.2), significant increases in length of stay (6.36; [CI, - 0.01 to 12.72]; p = 0.05), and higher inpatient costs ($22,628, [CI, $3587 to $41,669]; p = 0.02) than those not referred to PIM.Conclusions And RelevanceVHA intensive outpatient primary care was associated with higher costs. Referral to intensive case management programs targets the most complex patients and may lead to increased utilization and costs, particularly in an integrated healthcare setting with robust patient-centered medical homes.Trial RegistrationPIM 2.0: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project (PIM2). NCT04521816. https://clinicaltrials.gov/study/NCT04521816.© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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