Report: Having a PCP improves chronic disease prevention, management

Kids and adults with a PCP get more screenings

Using data from the Medical Expenditure Panel Survey, the researchers found that both kids and adults with a usual primary care provider were significantly more likely to be screened for key chronic illnesses.

For example, nearly all adults (95.5%) with a usual source of care received preventive services for chronic disease, especially heart disease. This compares with just 67.6% of adults without a usual source of care. Breaking these figures down by service type, adults with a usual source of primary care were more likely to receive the following services:

• Blood pressure checks (95.5% versus 67.6%).
• Cholesterol screening (89.2% versus 56.7%).
• Tobacco use screening (74.4% versus 48.6%).

This indicates that nearly every primary care provider is screening for risk factors related to heart disease, which the researchers said can ultimately help prevent heart disease. When irregularities arise, primary care providers can help coach patients in chronic disease prevention to stave off illness.

But it's not just heart disease that gets the attention of primary care providers. Adults with a usual source of care are also more likely to get the following types of cancer screenings:

• Mammogram (83.8% versus 54.2%).
• Colon cancer screening (79% versus 59.5%).
• Pap smear (84.4% versus 70.5%).

 Although cancer screenings cannot actually prevent cancer, they can help detect the illness early, improving outcomes.

These benefits are seen in a pediatric population, too, with children seeing a regular primary care provider being more likely to receive key childhood screening tests. For example, 95.6% of kids seeing a primary care provider get an obesity prevention screen, compared to 80.6% of kids who don't.

Meanwhile, 73.7% of kids seeing a primary care provider get a preventive vision screen, compared to 20.9% of kids who don't.

Kids seeing a primary care provider are about twice as likely to get an accident-injury prevention screening (43.7% compared to 21.7%) and a secondhand smoke exposure screen (37.1% versus 20.9%).

Primary care access supports chronic disease management

Even when kids and adults do have a chronic illness, their connection with a usual source of primary care benefits them.

For example, adults with a chronic disease who have a usual source of care were 20% less likely to be hospitalized and 11% less likely to have an emergency department visit for any reason, compared to those without a usual source of care.

Those trends were more pronounced among kids. Compared to those without a usual source of care, children with a primary care provider were 50% less likely to have an emergency department visit or hospitalization.

Fewer emergency department and hospital visits translate into overall lower healthcare costs for individuals with a usual source of care. For adults, having a usual source of primary care was linked with nearly 54% lower healthcare costs. For kids, that number was 40%.

These trends were even more pronounced for patients experiencing continuity of care, meaning they visit with the same primary care provider for a long time and have built a trusting and ongoing relationship. Continuity of care means there will be a stronger "therapeutic bond" that helps enhance long-term chronic disease management, the researchers said.

Building stronger primary care access

According to the Milbank researchers, building a stronger primary care network will make it easier for patients to enjoy the benefits of primary care. To get there, healthcare stakeholders will need to increase their investment in primary care.

For example, better Medicare reimbursement for primary care, particularly through the Advanced Primary Care Management codes and Medicare Physician Fee Schedule, could be effective.

Medicare might also consider redefining all primary care services as preventive, thus exempting them from cost-sharing requirements.

Also at the federal level, the Milbank researchers suggested policymakers expand primary care capacity in underserved areas, including by increasing community health center funding and enhancing reimbursement models.

On the state and Medicaid level, creating mechanisms to direct reimbursements directly into primary care clinicians and practices will be key. Supporting Medicaid reimbursement rates at parity with Medicare and requiring Medicaid managed care organizations to meet certain primary care spending targets could also be effective.

On the employer side, large employers can support primary care access by prioritizing employer-sponsored plans with benefit designs that promote access to primary care.

Finally, a concerted effort in the graduate medical education sector will be key. Specifically, addressing the cost of medical school and making it easier for those pursuing medical careers to choose a primary care specialty will be essential.

"Addressing the burden of chronic disease in the United States requires helping all Americans have access to a regular, trusted source of care, yet the number of people in the country who report having a usual source of primary care is declining," the researchers concluded.

Sara Heath has reported news related to patient engagement and health equity since 2015.