Spreading and Scaling Kaiser Permanente’s Primary Care Plus: An Interdisciplinary, Person-Centered Primary Care Model

https://doi.org/10.7812/TPP/18-071-14

From Colorado, Southern California

Background: Kaiser Permanente (KP) is committed to developing and implementing a systematic, crossregional plan to design, test, and scale programs addressing patients with complex health and social needs. The positive impact of Primary Care Plus (PC+) in KP Colorado (KPCO) resulted in a desire to further learn about person-centered primary care team models across KP. In early 2017, KP launched a direct replication of the PC+ model in KP Southern California’s (KPSC’s) Woodland Hills Medical Center to understand the impact and scalability of PC+.
Methods: KPCO’s PC+ followed strict eligibility criteria to capture high-need, persistently high-cost members older than age 65 years (or age 18-64 years who are enrolled in Medicare). The evaluation design was a prospective matched control study assessing cost and utilization of members from a single clinic at 12 months of enrollment. KPSC Woodland Hills’ PC+ adheres to the same eligibility criteria, but the evaluation is a randomized controlled study design using an intention-to-treat approach. The evaluation will assess costs, utilization, and quality of life. All primary outcomes measures will be measured at 12 and 24 months from baseline.
Results: Most recent cohort study findings include statistically significant benefit in mean total health care costs at 12 months for PC+ members vs matched controls; cost savings in inpatient, Emergency Department, skilled nursing facility, and pharmacy expenditure buckets; and PC+ members were more likely to have been screened for depression and anxiety. In addition, the early assessment evaluation reported high satisfaction among practitioners, staff, members, and caregivers.
Discussion: As PC+ spread within KPCO and into KPSC, maintaining adherence to the patient population, core model components, and study design is critical in studying the long-term Triple Aim results of this complex care model. Documentation of PC+ protocols in an implementation guide played a critical role in the ability to spread the intervention to additional medical offices at KPCO and to a replication at Woodland Hills in KPSC. In 2017, Woodland Hills began replicating PC+, with consultative guidance from the KPCO PC+ leadership team; this allows for crossregional transfer and further study of this complex care model. Beginning in May 2018, PC+ will also be tested at the Los Angeles Medical Center in KPSC.