Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations

The Article in Brief

Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations

Andrew Bazemore , and colleagues

Background Although continuity of care is a defining characteristic of primary care associated with lower costs and improved health equity and care quality, there has been little research of continuity as a quality measure linked to policy-relevant outcomes. This study examines the relationship between physician-level continuity and health care expenditures and hospitalizations.

What This Study Found An ongoing patient-physician relationship is strongly associated with lower total health care costs and decreased hospitalization rates. Based on 2011 Medicare claims data for 1,448,952 beneficiaries receiving care from a nationally representative sample of 6,551 primary care physicians, researchers created physician-level claims-based measures of continuity of care utilizing four established methods. When tested, all four continuity measures were strongly correlated with health care expenditures and hospitalizations. Of the beneficiaries obtaining some care from primary care physicians in the sample, 1,178,369 (81 percent) obtained most of their care from these physicians. In analyses of one of the established continuity measures (the Bice-Boxerman Continuity of Care Index), adjusted expenditures for beneficiaries cared for by physicians in the highest continuity quintile were $6,920, 15 percent lower than those in the lowest quintile ($7,664). The odds of any hospitalization were 16 percent lower for those with the greatest continuity compared to the lowest levels.

Implications

• This study contributes to the overwhelming evidence of the value of continuity care, the authors suggest, and offers quality measures that can be used and prioritized in value-based payment models.
• As the American health care system shifts from paying for services to paying for value, continuity of care is one of several core tenets of primary care that should be incorporated into official primary care measures, according to the authors.