Equitable Access to Holistic Health Care

The Comprehensive Care Physician (CCP) model was created by Dr. David Meltzer and colleagues at the University of Chicago Medicine (UCM) to improve care for patients at increased risk of hospitalization by giving them the opportunity to receive inpatient and outpatient care from the same physician, reducing care fragmentation and leveraging the power of a sustained physician-patient relationship. Since 2012, Dr. Meltzer and colleagues at UCM have studied the effects of a CCP program on patients insured by Medicare or Medicare and Medicaid (dual-eligibles) through a 2,000-person randomized controlled trial (RCT) funded by the Center for Medicare and Medicaid Innovation (CMMI). The UCM CCP program includes five CCP physicians supported by a dedicated team of nurses, social workers and clinic staff. Findings from the CMMI-funded RCT show statistically significant improvements in patient satisfaction and mental health status and a 15-30% reduction in hospitalization compared to patients who receive inpatient care and outpatient care from different physicians. Recent analyses indicate improved outcomes and cost savings of $5,000-$10,000 per patient per year in traditional Medicare patients and improved outcomes, with no increase in costs, in dual-eligible patients.  

In 2016, recognition of opportunities to increase the effectiveness of CCP for dual-eligible patients with high levels of unmet social need led to the development of the Comprehensive Care, Community, and Culture Program (C4P). C4P was established at UCM in partnership with the University of Chicago Health Lab with funding from the Robert Wood Johnson Foundation. Since 2019 C4P has been studied in an RCT funded by the Patient Centered Outcomes Research Institute (PCORI). C4P builds upon CCP to add: 1) systematic screening of unmet social needs across 17 domains, 2) access to a community health worker to help address unmet social needs, and 3) access to a community-based arts and culture program, the Artful Living Program (ALP). Early findings indicate that C4P patients have 30% lower hospitalization rates than patients in CCP and that reductions in hospitalization were even higher in patients predicted to be less likely to engage in care based on engagement before randomization. Enrollment in the PCORI-funded study of C4P is expected to complete in Summer 2026, with results on effects on outcomes, hospitalization, and costs over 1 year expected as early as late 2027.