Withlimited access to their main PCP, patients with manageable chronicconditions may delay treatment to the point of needing emergencycare. (Photo: Shutterstock)

It takes time to establish a relationship with a doctor. Butonce formed, it sets the stage for both the patient and provider toopenly engage, communicate, and trust the treatment plan. Thispatient-centered, shared decision-making results in higher qualitytreatment, better health outcomes and lower costs. Healthierpatients leads to a healthier community from which employers drawtheir workforce, which can have a profound impact on an organization's bottomline.

Unfortunately, patient-provider relationships may be disrupteddue to a shortage of primary care providers (PCPs),turnover within practices and plan sponsors' network changes. Tounderstand how this impacts patients and their employers, IBIdrew insights from an analysis by our ThomasParry research fellow Adrienne Sabety, a PhD candidate in HealthPolicy Economics at Harvard University. The study shows in detailhow disruptions in patient-provider relationships influence healthcare consumption and overall health, with implications forbusinesses and workforce health management decisions.

Related: Patients being priced out of primarycare

Sabety analyzed what happens when there are disruptions to PCPrelationships in a Medicare population and found:

• Primary care visits decrease by 17% for at least four yearsafter loss of a PCP.
• The impact on health is seen in increased deaths (up 50 deathsper 100,000 individuals) and use of emergency departments andinpatient admissions—often for treatable conditions, and at anincrease of $16,052 to payers. Patients end up switching to moreexpensive specialists for primary care, increasing patient spendingto $4,640 per exiting PCP.
• Team clinics minimized the negative effects of an exiting PCP,as patients can more easily rely on back-up relationship.

Why does this matter to the business community?

While this study focused on a Medicare population, there areimplications for employers. Most directly, health care systems andclinics are businesses themselves. One in nine employees in theUnited States works in the health care sector, and disruptions inpatient-provider relationships threaten those business operations.The research shows that a PCP's departure results in a decrease inpatient visits to the clinic. That loss of business is sustainedfor the next four years.

Additionally, for commercially insured health benefits, plansponsors' decisions to narrow or change networks could disruptemployees' primary care relationships, leading to more use ofcostly specialty and emergency care. Declines in health amongemployed patients will inevitably affect their employers in theform of sick day absences, impaired job performance and extendeddisability leaves. This in turn can translate into operationallosses if absent employees possess specialized skills and knowledgeor if extended leaves jeopardize business relationships withimportant clients. In this respect, the patient-providerrelationship becomes a critical first link in a chain that connectsworkforce health to productivity, business output and the successor failure of the business.

It is also worth remembering that employer-sponsored healthinsurance covers almost half of Americans' health care and that theUS workforce is aging. By 2028, nearly 1 in 10 US workers will be at least 65 yearsold—a 50% increase compared to 2018. In this light, the findingsprovide a reminder that plan sponsors' decisions may have long termimplications for employees' health, well-being and ability tocontribute fully on the job.

Societal disruptions caused by the COVID-19 pandemic may furtherstrain patient-provider relationships. With limited access to theirmain PCP (or fear of visiting health care facilities), patientswith manageable chronic conditions may delay treatment to the pointof needing emergency care. Alternative care arrangements such astelemedicine have filled some of the gaps during the pandemic butmay still pose challenges to developing trust-based relationshipsthat make primary care effective.

Employers can minimize disruptions to patient-providerrelationships

By considering some basic guidance, plan sponsors can avoidunintended consequences of disrupted patient-provider relationshipswhen making changes to benefit plans and network coverage.

Educate employees about the value of having a medicalhome.

Medical homes provide a system of care where collaborativeprovider teams help patients navigate the complex health caresystem to access primary, specialty, and emergent treatments.Employers should consider plan designs that incentivize providersand employees to engage with a medical home focused on primary andpreventative care.

Enlist services of ancillary providers and navigationvendors to fill in gaps in care.

Medical homes also provide a team setting inwhich pharmacists, nurse practitioners, and other supportingproviders can coordinate patient care delivery as a safeguardagainst disruptions in primary care. This helps patients remain intouch with non-physician team members who are informed about fortheir individualized care plans.

Contract directly for primary careservices.

Many employers have opened onsite clinics to make access to PCPs easierfor employees. In this fashion, employers can align incentives ofthe onsite-clinics with those of their organization—providing highquality care with the best clinical outcomes all while doing so ina cost-effective manner.

Analyze data to direct decisions around plan design anddisease management.

When constructing benefit plans, it is important to use data toassess any impacts of network changes, to tailor employeeengagement strategies, and to direct care management outreachefforts. Risk-adjusted quality metrics for in- and out-of-networkproviders, combined with workforce summary reports of chronicconditions, health risks, and sociodemographic information that mayindicate heightened needs for care—such as age and neighborhoodcharacteristics—can help finetune assessments of needs andavailable resources.

Research demonstrates clearly that relationships with PCPsprovide value to patients, their employers, and the businesscommunity at large. Yet the COVID-19 pandemic will continue todisrupt patients' access to primary care for the foreseeablefuture, widening the care gap for serious chronic illnesses andmental health conditions.

Employers' ability to recover from the long interruption ofnormal business operations will depend heavily on reengagingemployees who are healthy and ready for work. It may be moreimportant than ever that health benefits align care options withemployees' needs, preference and values. The result will behealthier employees, more robust and adaptive networks ofproviders, lower treatment costs, and better business outcomes forplan sponsors.

Brian Gifford, PhD, is research director atIntegratedBenefits Institute.

Read more: 

• Private investment in primary care, onsite clinicssurging
• Employee education can reduce unnecessary ERvisits
• U.S. spending less than other countries on primarycaredisruptions in patient-provider relationships influence healthcare consumption and overall health,