By The American Journal of Managed Care
The high and growing cost of healthcare is a significant issue in the United States, with hospital care representing the largest component (31.1%) of national healthcare expenditures.1 In 2008, there were an estimated 39.9 million hospital discharges (131 per 1000 persons) in the United States, with an estimated total aggregate cost of $364.7 billion.2 Medicare was the expected primary payer for the largest number of discharges (14.9 million, 46.2%), followed by private insurance (14.1 million, 32.2%).2,3
Some hospitalizations for ambulatory care–sensitive conditions, such as diabetes and chronic cardiac and respiratory diseases, can potentially be prevented with timely and effective ambulatory care. Diabetes with complications was in the top 20 most expensive conditions requiring hospitalization for Medicare in 2008.3 In addition, coronary artery disease and acute cerebrovascular disease (stroke) ranked among the top 10, while congestive heart failure, heart attack, pneumonia, and respiratory failure ranked among the top 20 most expensive conditions for both Medicare and private insurance in 2008.3 In 2006, hospital costs for potentially preventable (ie, ambulatory care–sensitive) conditions were approximately $30.8 billion (1 of every 10 dollars of total hospital expenditures), and as many as 4.4 million hospital stays could possibly have been prevented with better ambulatory care, improved access to effective treatment, and/ or implementation of healthy behaviors.4 Therefore, reducing the frequency of potentially preventable hospitalizations would be an effective strategy for lowering costs while improving quality of care and outcomes.4
In 2001, the Institute of Medicine issued its vision for reinventing healthcare in the 21st century to foster innovation and improve the delivery of care, which included patient-centered, responsive, and timely approaches to care.5 One new model that has emerged in the United States that seeks to address this issue is personalized preventive care, which focuses on prevention and wellness while delivering a high quality of care. This model is based upon consumer/patient empowerment, greater focus on preventive services, increased physician availability, and access to other healthcare resources. MDVIP (MD – Value in Prevention) is the first company to establish a network of primary care practices that delivers personalized healthcare in this new way. The MDVIP model of comprehensive management focuses on personalized preventive healthcare by delivering a host of screenings (eg, depression, anxiety, sleep, nutrition, sexual function, vision, and hearing) and diagnostics (eg, expanded testing for diabetes, bone disease, and cardiovascular disease) for a membership fee of $125 to $150 per month. MDVIP practices limit the number of members in each practice (<600 patients per physician) to be able to logistically deliver the service, thus allowing physicians to provide more personalized attention to manage all relevant health issues including acute concerns, chronic disease, and preventive screening, not just the diagnosis and treatment of illness.6 Traditional practices have over 2000 patients7 and do not have the time to provide many preventive services.8 MDVIP founders calculated the amount of time it would take to deliver a comprehensive preventive wellness program yearly and be able to follow up with chronic issues, thus capping the number of patients at 600 for each physician. As a result of the smaller practice sizes required to be able to provide the services, MDVIP members also receive same-day or next-day appointments for urgent and nonurgent care and the ability to reach their primary care physician (PCP) 24 hours a day. This model is not a third-party payer, and the fee covers only the extended prevention and wellness services provided by the PCP; therefore, members still need traditional health insurance to cover the costs of inpatient and outpatient visits, services provided by specialists, and other medical services (eg, laboratories, Xrays).6 In this model, MDVIP believes that the focus on prevention and wellness and the additional attention and time (ie, high quality of care) will lead to lower hospital utilization and ultimately lower healthcare costs. In an early effort to assess the impact of the MDVIP model on hospital utilization, we compared the hospital inpatient discharge rates from MDVIP members from 5 mandatory reporting states to nonmembers within the same states over a 5-year period.