Primary care is often patients’ first point of contact in the health care system. Expanding, advancing, and enhancing primary care is a key priority area for the New York Health Foundation’s grantmaking.
In this report, commissioned by the New York Health Foundation and produced by Milliman, researchers looked at insurance claims for nearly 2 million commercially insured New Yorkers to understand the association between primary care utilization and overall cost of health care. The independent analysis assessed the amount of primary care and preventive services members received and its association with total cost of care, as well as with emergency room visits and hospital stays, both in the same year and the year that follows.
Overall, the study found that associations between primary care use and health care cost varied by health risk level. For individuals in the highest and medium-to-high risk groups—both in the current year and the following year—higher primary care use was associated with lower total cost of care, up to an optimal level. In one scenario modeled—treating the hypothetical relationship as opposed to cause-and-effect—providing high and medium-high risk members with two additional primary care visits is projected to reduce total spending by $26.10 PMPY in the first year and $79.20 PMPY in the following year.
It is important to note that because this observational, claims-based study modeled associations rather than causation, the individual-level simulations and state-level extrapolations should be interpreted as illustrative cost ranges under stated assumptions.