Focus on Sickest in Medical Homes Saves Costs in Pilot Test

Consulting firm Mercer has just wrapped up what it terms an intensive primary-care pilot project with a large unidentified Dallas employer.

Dallas was the third test of a concept Mercer calls an ambulatory intensive care, or A-ICU. The employer sent its highest-risk patients to Plano-based Village Health Partners (VHP) and Baylor Scott & White’s physician subsidiary, HealthTexas Provider Network.

Unlike traditional patient-centered medical homes, the A-ICU model matched a select group of high-performing physicians with chronically ill patients who required intensive, customized care.

The model was based on a group of medical-home innovators described in a 2009 Health Affairs article as ‘American Medical Home Runs.’

Eric Bassett, Mercer’s Dallas-based senior partner, said the DFW pilot netted 20 percent savings after program costs and physician incentive payments. He said the gross savings was 27 percent, compared to the anticipated costs for those patients.

The model’s creators believe the same methodology could produce savings between two and three times greater than that among patients 65 and older.

Bassett said the Dallas results were similar to those in the previous pilot tests. He said program participants were selected from among the 20 percent of employees who were expected to generate the highest healthcare costs for their employer. Bassett said the 20 percent most expensive employees typically represent 50-60 percent of a company’s medical claims costs. Employee participation was voluntary, and often encouraged by the use of incentives such a gift cards or a series of free office visits.

Bassett said patient-centered medical homes (PCMHs) have improved healthcare quality but have not produced adequate savings because care is too broad.

“We try to get the right person into the right setting, and get them the right services at the right time,” he said.