Does increasing primary care team panel size affect health care costs: Findings from a VHA pilot program

In the Veterans Health Administration (VHA), primary care is delivered through a team-based medical home called the Patient Aligned Care Team (PACT). Increasing team panel size is one approach to addressing staffing challenges in primary care.

To examine whether alternate staffing models that expand team panel size results in greater medical costs.

Quasi-experimental approach comparing pre-post changes in costs between patients assigned to PACT teams with expanded and standard panel sizes, respectively. We analyzed data from VHA's Corporate Data Warehouse linked to cost data from the Managerial Cost Accounting System. Costs were analyzed using two-part modeling to account for the high proportion of zero-cost observations, and adjusted for patient demographics and comorbidity.

VHA patients assigned to the PACT team panels at three geographically diverse medical centers between October and December 2021.

Total medical costs were measured as expenditures on all health care services delivered in VHA facilities or from contract providers in the community. Secondary analysis separately examined costs of VHA delivered and contract care.

At each medical center, implementation of staffing models that increased panel size did not result in statistically significant changes in total medical costs and costs of care delivered by VHA facilities but was associated with a decrease in costs of contract care at one site.

Increasing PACT team panel size above standard levels in VHA did not increase patient-level costs. These results can help guide health system leaders to determine appropriate panel sizes and support staffing needed to meet the needs of patient populations.