New JAMA study show results in better clinical outcomes and lower costs

New JAMA study shows that integrating mental and physical health through primary care teams results in better clinical outcomes and lower costs

Evidence from a 10-year study conducted by Intermountain Healthcare shows it is possible to deliver high quality patient care while simultaneously reducing costs using team-based care within an integrated delivery system.

A major new study in JAMA shows that delivering integrated mental and physical healthcare in team-based primary care settings at Intermountain Healthcare results in better clinical outcomes for patients, lower rates of healthcare utilization, and lower costs.

The study is published in the August 23/30 issue of the Journal of the American Medical Association. It was accompanied by an editorial in JAMA that heralded the benefits of integrated mental health care.

The 10-year study — which is one of the largest studies of its kind — shows the benefits of care provided by team-based providers in an integrated delivery system. The study, which was conducted by Intermountain Healthcare researchers, measured 113,452 adult patients who received care from 2003 through 2013 in 113 primary care practices at Intermountain, including 27 team-based medical practices and 75 traditional practices.

What are the results of the study (and the clinical benefits of team-based care)?
• A dramatically higher rate of patients in team-based practices were screened for depression — which allowed care providers to provide medical and behavioral interventions earlier — compared to patients in traditional practices. 46.1 percent of patients in team-based practices were diagnosed with active depression compared to 24.1 percent in traditional practices.
• 24.6 percent of patients in team-based practices adhered to diabetes care protocols, including regular blood glucose testing, compared to 19.5 percent in traditional practices — which demonstrated how well patients engaged with care teams in working together to manage their health.
• 48.4 percent of patients in team-based practices had a documented self-care plan to help them manage their health conditions, compared to 8.7 percent in traditional practices.
• The study used high blood pressure as a control variable — meaning care management for that condition wasn’t yet changed in the Team-Based Care model so that researchers could have a reference point. Eighty-five percent of patients in the Team-Based Care group had controlled high blood pressure, compared to 97.7 percent in traditional practices. As researchers predicted, high blood pressure management did not show the same large improvements as shown for the conditions that Team-Based Care targeted, such as depression and diabetes. These results strengthen the link between Team-Based Care and the better clinical results shown in other areas.

Patients in team-based medical practices also used fewer healthcare services and had lower total costs, according to the study. Data showed that per 100 person years:

• The rate of emergency room visits was 18.1 for patients in team-based practices versus 23.5 visits for patients in traditional practices, which is a reduction of 23.0 percent.
• The rate of hospital admissions was 9.5 for patients in team-based practices versus 10.6 in traditional practices, which is a reduction of 10.6 percent.
• The number of primary care physician encounters was 232.8 for patients in team-based practices versus 250.4 for patients in traditional practices, which is a reduction of 7.0 percent.
• Payments to providers were $3,400 for patients in team-based practices versus $3,515 for patients in traditional practices, which is a savings of 3.3 percent. The payments were less than the investment costs Intermountain incurred in creating the team-based practice model.

How do patients benefit from team-based mental health services?
“For patients, the bottom line of the study is that getting care in a team-based setting where medical providers work hand-in-hand with mental health professionals results in higher screening rates, more proactive treatment, and better clinical outcomes for complex chronic disease,” says Brenda Reiss-Brennan, PhD, APRN, one of the study’s authors. “Team-based care means providers work together to care for all chronic conditions, mental and physical. At Intermountain, 80 percent of mental health services are provided by primary care physicians, and when they’re supported by an integrated team, both they and their patients benefit.”

Intermountain’s mental health integration model helps primary care and mental health providers collaborate to meet a patient’s physical and mental health needs during each patient visit. They do that by focusing on prevention and early diagnosis, integrating care processes, enhancing information systems and reporting methods, and partnering with community resources. Intermountain has embedded mental health screening and treatment within primary care physicians’ offices since 2000.

“Team-based care is just that, a team of healthcare providers from diverse disciplines — physicians, advanced practice clinicians, nurses, mental health providers, and other staff members — who work together with patients, families and communities to provide coordinated healthcare services,” says Dr. Reiss-Brennan. “The team works collaboratively with patients to set and accomplish shared goals for improving patient outcomes.”

Before the study, limited evidence was available to support the effectiveness of a care model that integrated mental health providers with primary care teams. “The study reinforces the value of coordinated team relationships within a delivery system and the importance of integrating physical and mental health care,” Dr. Reiss-Brennan says. “The study provides further evidence — from a mental health perspective — of Intermountain Healthcare’s hypothesis that better care costs less.”

The senior author of the study is Brent James, MD, MStat, Intermountain’s Chief Quality Officer and Executive Director of the Intermountain Institute for Healthcare Delivery Research. Other members of the research team included Kimberly Brunisholz, PhD, Carter Dredge, MHA, Pascal Briot, MBA, Kyle Grazier, PhD, Adam Wilcox, PhD, and Lucy Savitz, PhD.

Note: This research was supported by Intermountain Healthcare’s Medical Group, Primary Care Clinical Program, Institute for Healthcare Leadership, Office of Research, and Office of Population Health. Senior author on the study was Brent James, MD, MStat, Chief Quality Officer and Executive Director Intermountain Institute for Healthcare Delivery. Please see the JAMA article for other authors, additional information, including author contributions and affiliations, financial disclosures, etc

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