Increased access of patients with diabetes to physicians increases total costs but not cost growth
Health Care Costs and Financing
An initiative at an integrated regional health care system to increase patient access to providers and information increased total costs for enrollees with diabetes, according to a new study.
In 2003 the integrated health care system Group Health in Seattle increased patient-centered access by launching the MyGH Web site, providing enrollees with advanced access (same-day appointments) to primary care physicians (PCPs), providing direct access to some specialists, and making changes in PCP compensation to align with the initiative.
The researchers examined usage and costs for 9,871 members with type 1 or 2 diabetes who were enrolled continuously from 1998 through 2006. By the last quarter of 2006, 32 percent (3,127) of the enrollees had signed up and were authenticated to use the MyGH Web site. One-fourth of all enrollees sent secure emails to their providers in this quarter. During full implementation, primary care visits declined while primary care contacts (primary care visits and secure message threads) increased once secure messaging was introduced in 2003.
Visits with specialists rose slightly over the study period, and emergency department visits grew from 0.05 visits per person per quarter during the pre-initiative period to more than 0.10 visits per person quarterly during full implementation. Quarterly total costs of care (adjusted for inflation) rose from $1,946 in the first quarter of 1998 to $3,295 in the fourth quarter of 2006, but costs grew at the same rate (5.7 percent) in the pre-initiative period and during full implementation.
While the rate of change in pharmacy costs and specialty care costs fell modestly, but significantly, from pre-initiative to full implementation, the annual rate of change in primary care costs, emergency care costs, inpatient costs, and lab costs increased significantly between the two periods. The study was funded by AHRQ (HS14764).
More details are in "Does a large-scale organizational transformation toward patient-centered access change the utilization and costs of care for patients with diabetes?" by David Grembowski, Ph.D., M.A., Melissa L. Anderson, M.S., James D. Ralston, M.D., M.P.H., and others, in the October 2012 Medical Care Research and Review 69(5), pp. 519-539.