Impact of Primary Care Intensive Management on High-Risk Veterans’ Costs and Utilization

Jean Yoon
Evelyn Chang
Lisa V. Rubenstein
Angel Park
Donna M. Zulman
Susan Stockdale
Michael K. Ong
David Atkins
Gordon Schectman
Steven M. Asch
Journal Article
June 2019

This resource describes a randomized quality improvement trial that assessed whether augmenting usual primary care with team-based intensive management lowers utilization and costs for high-risk patients.

  • The trial took place at five U.S. Department of Veterans Affairs (VA) medical centers. The patients were primary care patients at high risk for hospitalization who had had a recent acute care episode.
  • The intervention consisted of locally tailored intensive management programs providing care coordination, health coaching, medication reconciliation, and home visits through an interdisciplinary team.
  • Of the patients assigned to intensive management, 44% received intensive outpatient care and 18% received limited intervention.
  • Mean inpatient costs decreased more for the intensive management than the usual care group. Outpatient costs increased more for the intensive management than the usual care group. Mean total costs were similar in the 2 groups before and after randomization.
  • High-risk patients with access to an intensive management program received more outpatient care with no increase in total costs.
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Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • What are the effects of supplementing primary care for high-risk patients with team-based management?
  • What is the evidence for these effects?
Level of Evidence
What does this mean?