BACKGROUND AND PURPOSE:

• Sonmez et al. (JAMA Network Open, 2023) examined the association between Medicare savings and primary care visit patterns

METHODS:

• Retrospective cohort study
• Population
  • A 5% sample of traditional Medicare claims from 2016 to 2019
  • Claims included in this sample came from participants with
    • ≥3 primary care visits with ≥180 days between the first and the last visit | Who were not enrolled in Medicare Advantage | Who did not have end-stage kidney disease | Who were not institutionalized
• Exposures
  • Primary care visit patterns
    • Visit frequency | Regularity | Continuity of care (saw the most responsible primary care clinician or organization vs other primary care clinicians or organizations)
• Primary outcomes
  • Savings in Medicare expenditures
  • Risk-adjusted Medicare expenditures | Number of emergency department (ED) visits | Hospitalizations

RESULTS:

• 504,471 beneficiaries
  • Mean age: 74.26 (SD, 10.41) years | Women: 59.16%
• Compared to the irregular noncontinuous group, the group with a regular and highly continuous pattern was associated with
  • Greater savings
    • 175.87% (95% CI, 167.40 to 184.33) | P<0.001
  • Lower risk-adjusted expenditures
    • −16.61% (95% CI, –16.73 to –16.48) | P<0.001
  • Fewer risk-adjusted ED visits
    • −40.49% (95% CI, –40.55 to −40.43) | P<0.001
  • Fewer risk-adjusted hospitalizations
    • −53.32% (95% CI, –53.49 to –53.14) | P<0.001
• Regular visits with higher continuity were associated with the highest savings
  • Savings increased with increasing visit frequencies
  • Peak savings were observed at higher visit frequencies as clinical complexity increased
• As regularity and continuity decreased, the association between savings and visit frequencies progressively inverted

CONCLUSION:

• Medicare savings were maximized when primary care visits were frequent, regular, and continuous regardless of demographics and clinical characteristics
• The authors state

Proactive approaches to primary care, defined by temporally regular visits with a continuity-of-care clinician at a frequency optimized for clinical complexity, may offer benefits to payers, clinicians, and patients by decreasing expenditures, reducing ED visits, and reducing hospitalizations

Learn More – Primary Sources:

Primary Care Continuity, Frequency, and Regularity Associated With Medicare Savings