How Proactive Healthcare Can Save on Costs

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.”