What Happens When Physicians Know the Total Cost of Care
A physicians practice learns important lessons about its referral and patient care patterns from a project that measures cost and resource data—and lets physician leaders see the reports.
When Portland, OR-based Family Medical Group Northeast found out that it had a high rate of patients showing up in local emergency departments because of behavioral health issues in 2013, leaders at the practice were confounded.
The primary care clinic is a Tier 3 Primary Care Home, a state designation that is similar to but separate from the NCQA's patient-centered medical home initiative, and has worked hard to coordinate care for its patients across multiple settings.
"It took us a couple of times before we said, 'What's going on?' " says Lisa Kranz, practice administrator for Family Medical Group Northeast.
Kranz was able to look at the practice's referral patterns, not only to area emergency departments, but also to specialists, because of a cost and utilization report made available to them and other healthcare providers by the Oregon Health Care Quality Corporation, Q Corp. is a Regional Health Improvement Collaborative (RHIC) that is part of a pilot project headed up by the Network for Regional Healthcare Improvement (NRHI) that measures the total cost of care. Kranz is on the cost of care steering committee at Q Corp.
"One of our aims with this project was to not only measure total cost, but also resource utilization," says Elizabeth Mitchell, President and CEO of NRHI. "We wanted to make sure groups had information about cost, and that they can see what is being driven by price, [and] what is being driven by utilization."
The main driver of Family Medical Group Northeast's high rates of behavioral health visits to the ED, says Kranz, was ultimately two-pronged. Physicians were not comfortable treating depression or other behavioral health issues that came up during a primary care visit because they didn't have the resources to do so.
And, there were no appointments available for patients at area behavioral health providers. "We sent them to the ER, which is a bad way of triaging, but it was the only thing we had in place," says Kranz. "Now, we have an agreement with a behavioral health provider who has agreed to take our patients within a week, and they can assess emergencies over the phone."
Kranz says physicians are also now getting trained on using the PHQ-9, a depression screening tool. She credits the total cost of care report as helping the practice improve the way it treats patients with a behavioral health need.