Association Between Physician Risk Assessment, Hierarchical Condition Categories, and Utilization of Medical Services.

Hierarchical Condition Categories (HCCs) are a common risk adjustment tool that may support alignment of care management resources with the clinical needs of a population. The authors examined the association between HCC scores and physician-determined clinical risk (CR) scores, annual charges, and utilization of medical care. CR score was defined as the anticipated risk for "ED or a hospital admission" within the following year. For each of the top 50 high-risk patients identified by total HCC score, the patient's primary care physician (PCP) entered a CR score based on their judgement. A total of 128 PCPs entered scores on 6167 patients of all ages across 31 primary care practices in the Finger Lakes Region of New York. Multiple correlation between HCC scores and physician CR scores was 44.0% (P < 0.001); only 18.5% of PCPs had a correlation >60%. There was a positive association between CR score and charges (slope 19.7K; P < 0.001) and between HCC score and charges (slope 25.7K; P < 0.001). Both HCC and CR scores were positively correlated (P < 0.001) with medical/surgical admissions, emergency department (ED) visits, and utilization of advanced imaging. Across a broad range of patients, HCC scores had a moderate-to-weak correlation with physician-determined CR scores for patients' risk of an ED visit or hospital admission. Both CR scores and HCCs scores were positively associated with charges and utilization. HCCs may assist in the allocation of health resources, but the relatively weak correlation with physician-determined CR scores warrants caution.

Impact of Patient-Centered Medical Home Transformation on Providers, Staff, and Quality.

The Patient-Centered Medical Home (PCMH) has become a widely implemented model to transform the delivery of care, but little evidence exists regarding the model's impact on providers, nurses, and staff. This study examined the impact of the PCMH model on (1) provider and staff satisfaction, (2) work-life balance, (3) teamwork, (4) professional experience, (5) patient care factors, and (6) quality outcomes. The authors confidentially surveyed physicians, advanced practice providers (APPs), nurses, care managers, and office staff in 2011 prior to implementation of the PCMH model and in 2016 after implementation at 34 primary care offices providing care to 171,045 patients. A total of 349 pre-PCMH implementation surveys (84% response rate) and 549 follow-up surveys (92% response rate) were received. Implementation of the PCMH model did not result in changes in provider, nurse, and staff responses to composite measures of satisfaction (P = 0.45), work-life balance (P = 0.68), teamwork (P = 0.26), patient care (P = 0.62), or professional experience (P = 0.14). Physicians and APPs experienced a negative, but mostly nonsignificant, change in all composite measures with implementation of the PCMH model. Quality markers improved for diabetes control HbA1c <8 (62.6% to 67.9%; P < 0.001), hypertension control (60.9% to 75.0%; P < 0.001), breast cancer screening (53.9% to 77.4%; P < 0.001), and colorectal cancer screening (43.9% to 70.3%; P < 0.001). Across a large primary care network, implementation of the PCMH model failed to improve overall satisfaction, work-life balance, teamwork, patient care, or professional experience. The model, combined with financial incentives, did result in improvements across multiple patient quality domains.