Primary care continuity can lower health care costs, study finds

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Regular visits with the same primary care doctor isn’t just good for patients’ health. It can also reduce national health care spending, a new study finds.

The study’s authors hypothesized that patients without a regular primary care provider, and who received care at irregular intervals, were likely only getting care in response to a medical problem. They also theorized that such “reactive” care is more expensive and more likely to involve acute care than is care from a doctor a patient sees regularly and with whom the patient has a strong relationship.

The researchers tested their hypothesis by examining fee-for-service claims from approximately 500,000 Medicare beneficiaries from 2016 to 2018. Each beneficiary had at least three primary care visits during the period, with at least six months separating the first and last visits.

They measured visit patterns along three dimensions: frequency (the mean annual number of primary care visits), regularity (the variability in the number of days between visits), and care continuity (the extent to which patients received care from their most responsible from their most responsible primary care provider or organization rather than another clinician or organization.)

Based on these dimensions, the researchers divided the study subjects into six categories ranging from “highly continuous regular” (seeing the same provider or provider organization at regular intervals) to “noncontinuous, irregular”.

The results showed “a clear association of primary care visit patterns with cost savings and utilization outcomes,” with the largest reductions in both risk-adjusted Medicare spending and acute care utilization seen among patients who received regular care with high continuity.

For example, per-patient spending in the “highly continuous regular” category averaged $8,367, compared with $14,269 in the “noncontinuous, irregular” category. Similarly, the former group had 305 emergency department visits and 159 hospitalizations per thousand patients compared to 640 and 283, respectively, for the latter.

The authors note that all outcomes in the study, including savings in Medicare spending, were tied to visit frequency and regularity, as well as continuity of care—a finding that they suggest has implications for Medicare’s stated goal of transitioning all beneficiaries to value-based care models by 2030.

“Given the interaction between these three characteristics, our results suggest that primary care systems and incentives under value-based care should be designed to optimize these three factors in combination,” they conclude.

The study, “Primary Care Continuity, Frequency and Regularity Associated With Medicare Savings” was published August 21 on JAMA Network Open.