With limited access to their main PCP, patients with manageable chronic conditions may delay treatment to the point of needing emergency care. (Photo: Shutterstock)

It takes time to establish a relationship with a doctor. But once formed, it sets the stage for both the patient and provider to openly engage, communicate, and trust the treatment plan. This patient-centered, shared decision-making results in higher quality treatment, better health outcomes and lower costs. Healthier patients leads to a healthier community from which employers draw their workforce, which can have a profound impact on an organization's bottom line.

Unfortunately, patient-provider relationships may be disrupted due to a shortage of primary care providers (PCPs), turnover within practices and plan sponsors' network changes. To understand how this impacts patients and their employers, IBI drew insights from an analysis by our Thomas Parry research fellow Adrienne Sabety, a PhD candidate in Health Policy Economics at Harvard University. The study shows in detail how disruptions in patient-provider relationships influence health care consumption and overall health, with implications for businesses and workforce health management decisions.

Related: Patients being priced out of primary care

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

• Primary care visits decrease by 17% for at least four years after loss of a PCP.
• The impact on health is seen in increased deaths (up 50 deaths per 100,000 individuals) and use of emergency departments and inpatient admissions—often for treatable conditions, and at an increase of $16,052 to payers. Patients end up switching to more expensive specialists for primary care, increasing patient spending to $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 are implications for employers. Most directly, health care systems and clinics are businesses themselves. One in nine employees in the United States works in the health care sector, and disruptions in patient-provider relationships threaten those business operations. The research shows that a PCP's departure results in a decrease in patient visits to the clinic. That loss of business is sustained for the next four years.

Additionally, for commercially insured health benefits, plan sponsors' decisions to narrow or change networks could disrupt employees' primary care relationships, leading to more use of costly specialty and emergency care. Declines in health among employed patients will inevitably affect their employers in the form of sick day absences, impaired job performance and extended disability leaves. This in turn can translate into operational losses if absent employees possess specialized skills and knowledge or if extended leaves jeopardize business relationships with important clients. In this respect, the patient-provider relationship becomes a critical first link in a chain that connects workforce health to productivity, business output and the success or failure of the business.

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

Societal disruptions caused by the COVID-19 pandemic may further strain patient-provider relationships. With limited access to their main PCP (or fear of visiting health care facilities), patients with manageable chronic conditions may delay treatment to the point of needing emergency care. Alternative care arrangements such as telemedicine have filled some of the gaps during the pandemic but may still pose challenges to developing trust-based relationships that make primary care effective.

Employers can minimize disruptions to patient-provider relationships

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

Educate employees about the value of having a medical home.

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

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

Medical homes also provide a team setting in which pharmacists, nurse practitioners, and other supporting providers can coordinate patient care delivery as a safeguard against disruptions in primary care. This helps patients remain in touch with non-physician team members who are informed about for their individualized care plans.

Contract directly for primary care services.

Many employers have opened onsite clinics to make access to PCPs easier for employees. In this fashion, employers can align incentives of the onsite-clinics with those of their organization—providing high quality care with the best clinical outcomes all while doing so in a cost-effective manner.

Analyze data to direct decisions around plan design and disease management.

When constructing benefit plans, it is important to use data to assess any impacts of network changes, to tailor employee engagement strategies, and to direct care management outreach efforts. Risk-adjusted quality metrics for in- and out-of-network providers, combined with workforce summary reports of chronic conditions, health risks, and sociodemographic information that may indicate heightened needs for care—such as age and neighborhood characteristics—can help finetune assessments of needs and available resources.

Research demonstrates clearly that relationships with PCPs provide value to patients, their employers, and the business community at large. Yet the COVID-19 pandemic will continue to disrupt patients' access to primary care for the foreseeable future, widening the care gap for serious chronic illnesses and mental health conditions.

Employers' ability to recover from the long interruption of normal business operations will depend heavily on reengaging employees who are healthy and ready for work. It may be more important than ever that health benefits align care options with employees' needs, preference and values. The result will be healthier employees, more robust and adaptive networks of providers, lower treatment costs, and better business outcomes for plan sponsors.

Brian Gifford, PhD, is research director at Integrated Benefits Institute.