Revamped community health center payment model drops imaging use by 42%

An alternative Medicaid payment model piloted in Oregon resulted in a sizeable reduction to traditional primary care services, fully attributable to a decrease in imaging utilization.

That’s according to claims and enrollment data covering 150,000 state residents between January 2010 and June 2017, published Tuesday in Health Affairs. Community health centers participating in the new model were reimbursed on a fixed per-patient basis as opposed to traditional per-visit systems.

And the change pushed providers to utilize more services that were typically non-billable under previous payment models. Its success may offer a blueprint for other states interested in implementing patient-centered home care models, lead author, Stephan Lindner, PhD, and colleagues at Oregon Health and Sciences University said in a statement.

"The point of the reform is to reduce services that aren't super valuable so that clinics can free up resources to get people the services they need," added Lindner, with the Portland institution’s emergency medicine department. "It frees up clinics toward services that can engage these patients in a different way, such as telephone consultations and basic health screenings."

Oregon’s Medicaid program imposed the payment change on certain health centers in 2013, and the researchers analyzed how that reform impacted five service areas, including: imaging, tests and procedures; other services provided by CHCs that were taken from the payment reform; emergency department visits; inpatient services; and other services of non-CHC providers.

The new model led to a 42.4% reduction in services, single-handedly caused by a drop in imaging procedures, such as radiography and ultrasound.

"That's a really strong signal," Lindner said, adding that their analysis showed patients did not receive imaging services at other institutions.

For example, the group noted that imaging for lower-back pain, while sometimes necessary, can often be treated using low-cost solutions like exercise, physical therapy and massage.

Imaging overutilization has long been a target to curb ballooning healthcare costs, with some measures, such as musculoskeletal code revisions, resulting in dramatic drops in overuse. A recent JAMA Internal Medicine study revealed low-value screening exams, such as chest radiography, can cost the health system up to $101 billion annually.

Lindner and colleagues said their research reveals solid evidence that changing provider incentives can lead to more efficient care.

“Our study showed that changing the primary care payment system to a fixed per member per month amount can be a way to eliminate such financial disincentives in primary care and may lead to changes in physician behavior—potentially reducing the use of low-value care,” the authors concluded.