Primary Care Visits Decrease by 25%: How Health Plans Should Respond

February 26, 2020 Health Ideas Staff

As Primary Care Visits Decrease, Can Member Engagement Help Avoid Serious Health Problems?

A recent study published in the Annals of Internal Medicine revealed several interesting trends related to adults and primary care. Researchers analyzed commercial health insurance data from 2008 through 2016 for Americans under 65. They discovered:

  • Visits to primary care providers decreased by nearly 25%.
  • The percentage of adults who went at least a year without seeing a primary care provider increased from approximately 38% to 46%.
  • Visits to primary care physicians for health problems decreased by more than 30%
  • Visits for preventive checkups increased.

The study team suspects that out-of-pocket healthcare costs may play a role in these findings. Between 2008 and 2016, the average cost to patients for a doctor’s visit related to a health issue increased from approximately $30 to close to $40. At the same time, the percentage of primary care visits that counted toward a patient’s health insurance deductible also increased from 10% to 25%.

These increased costs could explain why people are avoiding primary care visits for health problems, while continuing to see their doctors for preventive appointments which are often free or inexpensive due to the Affordable Care Act.

Decreased use of primary care physicians is a cause for concern for both patients and health plans. Several studies have concluded that individuals who see a primary care doctor are healthier. One survey found that American adults who used a primary care physician as their regular source of care had lower five year mortality rates than those who used a specialist. This finding controls for factors like differences in health status, demographics, health insurance coverage, health perceptions, smoking and reported diagnoses.

Can Preventive Care Sustain the Link to Primary Care Physicians?

One potential bright spot in the Annals of Internal Medicine study is that visits to primary care physicians for preventive checkups increased. A focus on preventive care may be the way to sustain the link between adults and their doctors, and potentially head off more serious health problems before they become crises that require a visit to the emergency room or urgent care.

HMS analyzed customer data and discovered that when members have a primary care doctor who they like, they have higher rates of preventive care gap closure than people without a PCP. The difference can be as high as 20% in some instances. Closing gaps in preventive care is beneficial for members and it’s also beneficial for health plans, since it decreases costs, increases revenue, and improves the quality of care.

Health engagement programs that include outreach campaigns encourage members to visit their primary care physician for annual wellness checkups. Health plans can identify individuals with preventive care gaps and then reach out to them using a variety of communication channels such as IVR phone calls, email messages and text messages.

Regardless of why Americans are reluctant to visit their doctors for health issues, the data is hard to ignore. Waiting until health problems become troubling or even unbearable isn’t a recipe for lower healthcare costs or higher healthcare quality. Focusing on preventive care as a way to identify members’ underlying health conditions, rather than merely treating symptoms, may be the best way to maintain the valuable relationship between adults and primary care physicians.

Previous Article
Embracing Our Irrational Side: How Behavioral Economics Can Improve Member Engagement
Embracing Our Irrational Side: How Behavioral Economics Can Improve Member Engagement

See more
Member Segmentation: The Key to Effective Care Management
Member Segmentation: The Key to Effective Care Management