Want to Cut Healthcare Utilization? Make Primary Care More Comprehensive

New research indicates comprehensiveness in primary care could be just as significant as care access and coordination.

Patients who receive comprehensive primary care have lower Medicare expenditures, fewer hospitalizations, and less emergency department visits, recent research shows.

More comprehensive care has been linked to improved care coordination; reduced diagnostic tests, medications, and interventions; health gains; lower costs; and improved equity.

"Our findings, when taken in the context of prior literature, suggest that promoting comprehensiveness of primary care could avert preventable ED visits and hospitalizations and lower overall costs," the authors of the recent study published in Health Services Research wrote.

The researchers examined three measures of comprehensiveness:

• Involvement in patient conditions: This new metric gauges the comprehensive of clinicians based on their involvement in the care of a broad range of patient health conditions.
   
• New problem management: This new metric measures how much a clinician manages a patient's new symptom or problem rather than making a referral to a specialist.
   
• Range of services: This previously established metric shows the range of services that a clinician provides to all patients.

The research is a leap forward in the ability to examine the comprehensiveness of primary care, the lead author of the study, Ann O'Malley, MD, MPH, told HealthLeaders.

"This work helps us assess comprehensiveness more deeply than prior work by adding two new measures—new problem management and involvement in patient conditions—and we demonstrate that both are important dimensions of primary care clinician comprehensiveness," she said.

O'Malley's research team found a high degree of new problem management was associated with reduced total Medicare expenditures, hospitalizations, and ED visits.

The research shines a light on comprehensiveness of primary care—an issue that has received insufficient attention in the past, O'Malley said.

"To date, comprehensiveness has received less attention than other key elements of primary care, such as access or continuity, which are more easily measured, and coordination, which is now the focus of a variety of new payment models. Without explicit measurement and support for its improvement, comprehensiveness may wither as other aspects of primary care such as access and coordination receive more resources and attention."

Expanding knowledge about comprehensiveness of primary care
 

The new study builds on earlier research about comprehensiveness of primary care and outcomes, she said.

"This work shows that particular aspects of primary care physician comprehensiveness—in particular the primary care physician's management of patients' new problems and the primary care physician's involvement in the care of a broad range of a patient's conditions—are associated with lower rates of emergency department visits, lower hospitalization rates, and lower total Medicare expenditures."

The new study also advances the understanding of how comprehensiveness impacts care, O'Malley said.

"This work adds to prior efforts, which have chiefly focused on comprehensiveness in terms of the types of services a primary care practice offers. Our analyses suggest that, for Medicare beneficiaries, high physician comprehensiveness on our two new measures is as important as assessing the range of services they provide."

She cautioned that the study's findings are useful to primary care researchers but have limited utility for applications such as payment models. "These claims-based measures are not suitable for high-stakes performance metrics for individual primary care clinicians or practices."