Primary Care Visits Fell Sharply From 2008 to 2016, Commercial Payer Data Shows

For a large, national commercial payer, primary care visits among health plan members decreased 24.2% from 2008 to 2016.

Patient utilization of primary care services have declined significantly in recent years, new research indicates.

Primary care has been associated with improved clinical outcomes and healthcare cost containment. Over the past decade, healthcare payment and delivery reforms such as accountable care organizations have sought to boost primary care visits across the country.

The new research, which was published this week by Annals of Internal Medicine, focuses on commercial payer data collected from 2008 to 2016. The data is from one commercial payer with patient members in every state and the District of Columbia. About 20 million patients were enrolled in the payer's health plans for each year of the study period.

Primary care visit data

The primary metric in the study is primary care provider (PCP) visit rates per 100 member years. The researchers examined claims data from 142 million primary care visits.

The research generated several key data points.

• Visits to PCPs fell 24.2% from 2008 to 2016.
   
• The decline in PCP visits during the study period was greatest among young adults (27.6% drop), patients with no chronic conditions (26.4% drop), and patients who lived in the lowest-income areas (31.4% drop).
   
• The percentage of adults aged 18 to 64 who did not have a PCP visit on an annual basis increased from 38.1% to 46.4% during the study period.
   
• Young adults (aged 18 to 34) were most likely to not have a PCP visit on an annual basis, with 48.2% having no PCP visits in 2008 and 56.7% having no PCP visits in 2016.
   
• Older adults (aged 55 to 64) were least likely to not have a PCP visit on an annual basis but also had fewer visits over time, with 26.6% having no PCP visits in 2008 and 33.9% having no PCP visits in 2016.
   
• PCP visits for medical problems fell 30.5% during the study period.
   
• PCP visits for preventative care increased by 40.6% during the study period.
   
• PCP visits for low-acuity conditions fell by 47.7% during the study period.
   
• Visits to alternative care settings, particularly urgent care clinics, increased by 46.9% during the study period.
   
• Patients faced higher costs for PCP visits during the study period. The out-of-pocket cost for PCP visits for medical problems increased 31.5%. The percentage of visits subject to a deductible increased from 9.2% in 2008 to 25.2% in 2016.

Interpreting the data

Three factors are likely driving the changes in primary care utilization, the researchers wrote.

1. Need for in-person PCP visits has decreased: "Declines were larger for younger, healthier adults, who may have fewer routine care needs and be increasingly comfortable with online self-care or a secure message with their clinician when acute needs arise. In kind, visit rates decreased sharply for low-acuity conditions, such as conjunctivitis, that might be addressed more easily by calling a nurse or searching the Internet," the researchers wrote.

2. Financial barriers: "In our data, we found that a growing proportion of primary care visits were subject to a deductible while out-of-pocket costs per visit increased. The decline in PCP visits was largest in low-income communities, consistent with prior work showing that lower-income adults are particularly sensitive to increases in out-of-pocket costs.

3. Replacing PCP visits: "Specialist visit rates remained steady. … Visits to alternative venues, such as urgent care clinics, retail clinics, emergency departments, and telemedicine, increased by 9 visits per 100 member-years, offsetting about one quarter of the PCP visit decline (35 visits per 100 member-years). The convenience of these alternatives may be particularly attractive compared with the often inefficient or inflexible scheduling practices in traditional primary care settings," the researchers wrote.