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August 15, 2019

Will Increasing Primary Care Spending Alone Save Money?

Author Affiliations
  • 1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 2Department of Medicine, Massachusetts General Hospital, Boston
  • 3Harvard Medical School, Boston, Massachusetts
JAMA. 2019;322(14):1349-1350. doi:10.1001/jama.2019.12016

Primary care, defined as core functions that patients receive from their usual source of care, is an essential component of health care and is associated with better-quality care, patient experience, and outcomes including lower mortality.1 Observational studies have also linked primary care to lower levels of spending.2 However, from a policy perspective, a key question is whether increasing primary care spending by a state or the nation would slow the growth of total health care spending.

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    2 Comments for this article
    Primary Care -- When to Begin?
    Michelle Sahl, PhD | Drexel University
    Cost savings from expansion of primary care will be most evident when it includes preventive care, instructed self-care, and utilization of PCPs and pediatricians beginning in childhood.
    Context, and Continuity, Matters
    Steven Merahn, MD | Union In Action, Inc
    When I was CMO for a national primary care practice and ACO serving complex/fragile patients, one of our payers sought to quantify the cost impact of our intensive primary care model. In their case-control claims assessment over 6 months, the variable that turned out to have the most power to reduce total cost of care was when our teams delivered 75% or more of care, with the greatest reduction in inpatient, outpatient hospital and emergency room use when our teams provided 100% of care, even after accounting for the increase in PCP line items associated with our model. For those patients who received less than 75% of care from us, primary care costs were even higher, as was inpatient utilization and ED use. While we were especially proud of our clinical discipline, this identified the relational factors of continuity and connection -- which we deemed "professional intimacy" -- as critical to quality, and the success of primary care to support Triple Aim achievement.