Many health plans put an emphasis on assigning members to a primary care provider. It may, however, be a good practice to invest the time to match members with the right primary care provider, so the members are motivated to see the same provider consistently.
The study entitled The Medical Home, Access to Care, and Insurance: A Review of Evidence states, “International and within-nation studies indicate that a relationship with a medical home is associated with better health, on both the individual and population levels, with lower overall costs of care and with reductions in disparities in health between socially disadvantaged subpopulations and more socially advantaged populations.”
Better Health
Members who have a PCP have been shown to have better health outcomes than members who do not consistently see the same PCP.
One study, The Role of Provider Continuity in Preventing Hospitalizations, showed that patients with better provider continuity for one year had significantly lower rates of hospitalization in the subsequent year.
Providers are better able to assess a patient’s risks, needs, and condition when they have knowledge of their medical history. Consistency also allows for increased trust and better communication in the doctor-patient relationship.
There is also evidence that suggests that patients are more likely to follow medical recommendations and are more satisfied with their care when they have a consistent PCP.
Lower Costs
According to the report, Provider Continuity in Family Medicine: Does It Make a Difference for Total Health Care Costs? Provider continuity with a family physician was, indeed, one of the most important variables related to the total health care cost.
The report explains, “Looking at the individual behavior of patients, a study reviewing all claims of a random sample of Medicaid patients (aged 0 to 21 years) for 3 years showed that continuity with the same practitioner was associated with a significant reduction in the number of hospital admissions and overall costs.”
Another study, The Role of Provider Continuity in Preventing Hospitalizations, showed that continuity of care with a provider is associated with a decrease in the likelihood of hospitalization for the study group.
Reduction in Health Disparities
Yet another study, Insurance or a regular physician: Which is the Most Powerful Predictor of Health Care?, pointed to the ways in which a consistent PCP can reduce health disparities. “Lack of a regular physician is a stronger, more consistent independent predictor than insurance status of each of our 3 measures of poor access to care: delay in seeking emergency care, no physician visits in the previous year, and no emergency department visits in the previous year.”
Assigning members to PCPs has long been a priority for health plans and, anecdotally, has been accepted as a best practice. However, the research is there to back the practice up. Members who have an assigned PCP are more likely to be in better health, result in lower health care costs, and experience a reduction in health care disparities.
