Both "High-Needs" Patients and Facility Leaders Praise VA's Intensive Primary Care Pilot Program
To address the needs of complex, “high-needs” patients, healthcare systems have piloted “intensive primary care” (IPC) programs that facilitate care coordination, provide care management and additional social services, and aim to engage patients and caregivers in their healthcare. While IPC programs have shown promise, quantitative evaluations in both VA and non-VA settings suggest that few have reduced healthcare use, cost, and mortality beyond usual care. However, it is likely that patients may benefit from IPC programs in other ways. This qualitative evaluation explored the perspectives of patients and healthcare facility leaders to identify additional important outcomes that could augment utilization and cost studies of IPC programs for high-needs patients. In 2014, VA’s Office of Primary Care funded five sites to develop and implement their own IPC programs. Investigators in this study conducted phone interviews with high-needs patients (n=51) and primary care facility leaders (n=15) at these five pilot sites in Georgia, North Carolina, Ohio, Wisconsin, and California. Patients were eligible to participate in study interviews if they had at least four encounters with the IPC team and at least one in the previous month.
- IPC programs can improve patient experience, engagement, and quality of care. Patients perceived improvements in their experience of VA care, including improved patient-provider relationships and access to their healthcare team. Primary care leaders also observed greater proactive patient engagement with the IPC team, increased motivation for health behavior change and self-care, and improvements in patient health behaviors, physical and mental health, and social needs.
- Many patients emphasized the importance of relationships, communication with their providers, and access to care and providers. Patients frequently reported feeling a sense of connection with their IPC team because they could rely on them for support with health and non-health-related issues.
- Some patients noted physical improvements in health, and patients also cited improvements in health behaviors (i.e., lifestyle changes and medication adherence).
- Despite benefits, patients and providers noted how some patient health characteristics (e.g., chronic health conditions) and contextual factors (e.g., housing insecurity) may have limited the effectiveness of the program on healthcare costs and utilization.
- IPC programs may yield benefits beyond healthcare cost and use, including improved quality of care, patient satisfaction, quality of life, and patient health behaviors. Future IPC program evaluations should consider examining IPC’s effect on these outcomes in addition to cost and use.
- Results suggesting improved patient health behaviors were based on patients’ and facility leaders’ subjective perceptions and not on objective health outcomes.
- Family caregivers were not interviewed but may have experienced improved outcomes from IPC.
Drs. Wong, Katz, Stockdale, Ong, and Chang are part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP).
Wong M, Luger T, Katz M, et al. Outcomes that Matter: High-Needs Patients’ and Primary Care Leaders’ Perspectives on an Intensive Primary Care Pilot. Journal of General Internal Medicine. May 13, 2021; online ahead of print.