Client(s): California Primary Care Association
Services: Applied Research & Evaluation, Health Systems Transformation
Technical Expertise: Health Care Reform, Safety Net
Measuring and understanding total per capita health care costs and underlying utilization of the total health system is a critical first step in managing them better as part of achieving Triple Aim goals of better care, better health and reduced per capita health care costs. Demonstrating how utilization metrics that have both a cost and a quality dimension - such as hospital readmissions - may differ for community health center patients can allow health centers to quantify and communicate their value within the health system.
Representing over 800 member community clinics and health centers, the California Primary Care Association engaged JSI in April 2011 to study the value of its member health centers, with particular attention to total cost of care for managed care Medi-Cal patients with a federally qualified health center (FQHC) as their usual source of care compared to patients using other settings.
JSI performed the following activities:
- performed claims-based, risk-adjusted total cost and utilization analyses of managed care Medi-Cal populations from two major health plans in California in order to understand how costs and utilization patterns differ for FQHC vs. non-FQHC patients
- identified potential future research opportunities for studying the cost effectiveness of FQHCs
- analyzed the limitations of using total cost of care as a metric, concluding that inpatient utilization metrics represent the best proxy for the value that health centers bring to the health system
The results of this study showed that FQHCs are clearly demonstrating value within the health system: adult FQHC patients had lower risk-adjusted odds of experiencing inpatient admissions, 30-day readmissions, and ED visits compared to adult non-FQHC patients. FQHC patients also had lower total costs of care than non-FQHC patients. This work has motivated at least one regional health plan and community health center network to investigate how total cost of care and utilization correlate with quality findings and patient-centered medical home assessment scores currently tracked by the health plan. The findings have also been used to inform discussions around payment reform and delivery system transformation.