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When CVS purchased Oak Street Health, a chain of primary care clinics, this past May for almost $11 billion, the company said the acquisition would be good for patients, particularly in underserved communities.
But the investment in primary care could also benefit insurers and taxpayers—and CVS itself, of course. Providing proactive rather than reactive healthcare may generate huge financial value, suggests research by Chicago Booth PhD student Dilara Sonmez, University of Chicago Medicine’s George Weyer, and Booth’s Dan Adelman. Primary care providers and healthcare organizations can reap the greatest benefits by implementing a proactive care strategy that encourages patients to have regular primary care visits with the same PCP, according to the study.
Patients who seek primary care services when feeling unwell or experiencing symptoms from chronic conditions, such as elevated blood sugar and complications from diabetes, are receiving reactive care, the researchers write. These patients are more likely to wind up in the hospital, requiring insurance to cover those costs.
But patients with chronic conditions who visit their PCP on a regular basis likely receive medication and appropriate testing, which helps them avoid complications and hospital stays.
To quantify the impact of proactive care, the researchers obtained data from Medicare, the United States’ federal medical-insurance program mostly for people aged 65 and over. Medicare expenditures were $747 billion in the most recent fiscal year, about 12 percent of total federal government spending. Hospital expenses were the largest single component of that, accounting for nearly 40 percent of the program’s outlays.
Research exploring the benefits of proactive healthcare found savings were biggest for those patients who received regular, continuous care from the same doctor.
The sample of Medicare claims Sonmez, Weyer, and Adelman analyzed spanned 2016 to 2019 and included the primary care visits of more than 500,000 continuously enrolled individuals. The study measured visit frequency; regularity of care, defined as the variability in the number of days between visits; and continuity of care, the extent to which a patient was under the care of a single PCP.
The researchers examined patients’ actual Medicare expenditures for 2019 and compared them with what were expected as expenditures given various health and demographic information about the patients. Medicare’s calculated savings were the difference between expected and actual expenditures. (Because actual expenses were higher than expected expenses in some cases, it was possible for Medicare savings to be negative.)
The researchers created six comparison groups for the study organized by a patient’s continuity of care: regular and highly continuous, irregular and highly continuous, regular and moderately continuous, irregular and moderately continuous, regular and noncontinuous, and irregular and noncontinuous.
The researchers find that for all patients, Medicare savings grew as continuity of care increased, but the savings were only positive for those patients in the high-continuity groups. Continuity was so important that patients with highly continuous care experienced savings no matter which frequency or regularity group they fell into—but for patients at any particular level of continuity, savings were highest for those who received regular care too.
The optimal frequency of care for the highly continuous group varied according to the complexity of patients’ medical conditions: savings increased with visit frequency for patients with more complex care needs, topping out at 10 visits per year for medium-risk patients, whereas lower frequency was associated with higher savings for patients with lower-risk medical profiles.
It’s well documented that continuity of care results in better patient health outcomes, says Weyer, who explains that while physicians want to provide regular, continuous care for their patients, various factors make that difficult in certain situations. But addressing those factors would benefit patients, health systems, and healthcare payers such as Medicare (and taxpayers, by extension). “Health systems, provider groups, and policy makers need to think about what these facilitators and barriers are for providing this care,” he says.
Medicare has spent two decades shifting away from a fee-for-service model and toward a value-based payment model that rewards healthcare providers on the basis of the quality of their care along various measures. The findings suggest that as health systems and provider groups make this transition, they should prioritize regular, continuous care for patients. Doing so, the researchers write, “may offer benefits to payers, clinicians, and patients by decreasing expenditures, reducing [emergency department] visits, and reducing hospitalizations.”
Dilara Sonmez, George Weyer, and Dan Adelman, “Primary Care Continuity, Frequency, and Regularity Associated with Medicare Savings,” JAMA Network Open, August 2023.
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