Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients

Area of Science:

• Health Services Research
• Primary Care
• Health Economics

Background:

• High-need, high-cost (HNHC) patients often have multiple chronic conditions, including behavioral health issues.
• These patients face challenges accessing primary care, leading to high emergency department (ED) use and costs.
• Primary care practices are seeking strategies to improve care delivery and reduce spending for HNHC populations.

Purpose of the Study:

• To examine the relationship between primary care structural capabilities and ED utilization among HNHC patients with behavioral health conditions.
• To identify which structural capabilities are most effective in reducing ED visits for this vulnerable population.

Main Methods:

• Cross-sectional survey data on practice capabilities from 240 primary care sites were linked with Medicare claims for 70,182 HNHC patients.
• Data from Arizona and Washington practices were analyzed using multivariable Poisson models.
• The study focused on HNHC patients with depression, alcohol use, and substance use disorders.

Main Results:

• Shared communication systems were associated with significantly lower rates of all-cause and preventable ED utilization for HNHC patients with alcohol use and substance use disorders.
• Care coordination showed a similar association with reduced ED use for the overall HNHC group and those with alcohol use.
• Care coordination did not demonstrate a significant association with reduced ED utilization for HNHC patients with depression or substance use disorders.

Conclusions:

• Implementing shared communication systems in primary care can enhance the effectiveness of care for HNHC patients with specific behavioral health conditions.
• Care coordination strategies may also benefit certain HNHC subgroups, but further research is needed.
• These findings highlight the potential of structural capabilities to optimize primary care delivery and reduce healthcare costs.