Frequent routine primary care visits for adults with high clinical complexity can reduce costs, according to a study reported in the American Journal of Managed Care.
Although it helps provide preventive services, manage chronic conditions and coordinate patient care, the United States trails other high-income nations in total health care spending for primary care. Previous studies have shown that the frequency and consistency of interactions with primary care under Medicare has a positive effect on both health outcomes and the overall cost of care. Patients with high levels of clinical complexity tend to benefit more from more frequent engagement with primary care.
Researchers sought to determine if adults aged 18 to 64 with an insurance policy other than Medicare, Medicaid or other public coverage enjoyed the same benefits. Participants who met these criteria had a mean annual cost of care of nearly $7,700. The results showed a relationship between primary care visit frequency and health care expenses similar to those for Medicare-insured adults.
“Our analysis found a significant association between primary care visit frequency and health care costs within a nationally representative sample of commercial patients, wherein the incremental predicted effect of more routine visits varied by clinical risk,” the report said. “These findings suggest that for patients with underlying clinical complexity, cost savings vs. prediction are often achieved for those with more frequent, nonacute interactions with primary care.”
For patients with lower clinical risk, however, additional routine and acute visits were associated with higher overall expenditures. These patients are less likely to have sources of health care costs outside of primary care for which treatment could have an immediate impact, so this positive relationship is due in large part to the cost of the primary care visits.
These results are consistent with previous studies finding a significant association among primary care visit frequency, inherent risk and costs among Medicare-eligible patients. The finding of a comparable link among higher-risk commercial patients suggests that the value of more frequent visits to primary care is driven more by underlying patient clinical risk than the coverage model.
“Higher-risk patients could benefit from more-frequent routine visits, potentially resulting in lower overall health care expenditures,” the report said. “High-touch primary care models currently used in Medicare populations could be appropriate for commercial patients as well. Understanding this relationship can help health care providers, insurers and policymakers consider advanced primary care models in commercially insured populations.”
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