Comparing costs of a senior wellness care redesign in group and independent physician practices of an accountable care organization.

Bustamante AV1, Martinez A2, Rich J3, Chen X2, Rodriguez HP4.

Author information

1: Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
2: UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
3: HCP Institute for Applied Research and Education, El Segundo, CA, USA.
4: Department of Health Policy & Management, UC-Berkeley, Berkeley, CA, USA.

Abstract

Primary care redesign for older adult patients is currently ongoing in countries with aging populations. One of the main challenges of this type of transformations is how to estimate implementation costs in different types of health care delivery organizations. This study compares start-up and incremental expenses of implementing a primary care redesign across 2 organization types: integrated group (n = 31) practices and independent practice association (IPA) sites (n = 213). Administrators involved with implementing the redesign completed a cost capture template to quantifying expenses. The potential impact of measurement error, recollection bias, and implementation models across sites and geographic regions was examined in sensitivity analyses. Marginal start-up and incremental expenses were higher for Group sites ($122-$328) compared to IPA sites ($31-$227). Group and IPA sites, however, implemented the redesign with different intensities. According to our analyses, if IPA sites implemented the redesign with the same intensity as Group sites, marginal costs would have been $5 to $13 higher for IPA sites than for Group sites. This study shows how a flexible approach to estimate the cost of a wellness care redesign is needed when the intensity of the transformation differs across 2 different types of health care organizations.