Integrated Care in a Large Public System Improves Benign Prostatic Hyperplasia Management.

INTRODUCTION

Understanding the impact of innovative models to improve health care management for underserved populations can help to develop care pathways that maximize our ability to deliver high-quality care at a lower cost. Our objective was to utilize time-driven activity-based costing to compare patient burden and cost of benign prostatic hyperplasia (BPH) diagnosis, workup, and management with clinical integration vs traditional care pathways, and to evaluate the relative cost-effectiveness of various care models.

METHODS

In this quality improvement effort at the Los Angeles County Department of Health Services, clinical care was integrated between specialists and primary care providers (PCPs), allowing comanagement for common conditions. We analyzed cost and patient burden using space, personnel cost, and time data from the 2024 fiscal year to compare care with the integrated care model and through traditional care pathways. We constructed workflow and process maps to capture the full patient journey from initial encounter to surgical intervention. We then used time-driven activity-based costing to quantify costs, time, and process steps in both care models.

RESULTS

Without the use of clinical integration, urologist time needed to manage a patient with BPH was 66 minutes, while total urologist time with clinical integration was 36 minutes. PCP times were 66 and 36 minutes with and without integration, respectively. Cost difference between integrated and nonintegrated pathways was greatest when presenting to the PCP with concerns for BPH with a cost difference of 12.3% ($336.03 vs $383.23). Significant but lower cost differences were found when presenting to the emergency department not in urinary retention (10.7% difference, $393.05 vs $440.25) and when presenting to the emergency department in urinary retention (5.0% difference, $327.05 vs $344.23).

CONCLUSIONS

The integrated model showed cost savings, particularly through initial management by PCPs and with streamlined transitions from PCPs to specialists. Clinical integration resulted in more cost-effective BPH care for the patient, providers, and health system. The integrated approach may enhance access to specialty care while minimizing treatment burden and health care expenditures.