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Is Insurance to Blame for Fewer PCP Visits?

Primary care is thought to serve as the pinnacle of the health care system as the initial and hopefully a one-stop- shop for timely and cost-effective care. Primary care includes health awareness, disease prevention, health maintenance, patient education and counseling, and diagnosis and treatment of acute and chronic illnesses, all of which are thought to be covered by commercial health insurance.1 Primary care is served by a team of professionals including office management, nurses, medical assistants, doctors, mid-level practitioners, pharmacists, imaging personnel, laboratory technicians, and consultation services from outside practices. With most of these facilities in close proximity, easily accessible, and covered by most insurance plans, one would think primary care provider (PCP) visits and business would be booming, but is it?

A new study in the Annals of Internal Medicine showed that commercially-insured adults were found to have visited primary care providers less often, and one in two had no PCP visits in the last year.1 The researchers analyzed data from a national sample of adult health plan members between 18 and 64 years of age and saw that visits to PCPs fell by 24.2%. At the same time, the percent of plan members with no PCP visits in one year increased from 38.1% to 46.4%.1 Important to note that the biggest decline in visits was among younger adults, patients without chronic conditions, and health plan members living in extremely low income areas.1 Researchers blame the decline in primary care largely in part to perceived visit needs, financial barriers like co-payments, and the use of alternative sources of care.1

As pharmacists, we are thought to be the first stop in the healthcare process because we are readily available and do not require an appointment for consultation. We are trained with an understanding of medications, disease state management, and the basics of how co-payments operate. Due, in part, to these reasons, patients often ask for our opinion of how, when, and where to be seen by a physician if even necessary.

Some of the frustrations or questions patients have in regards to electing to not go to PCPs include: why does it take so long to get an appointment?, why is my copay so high?, when I do finally get an appointment it seems like my physician says things will clear up without treatment, my physician always wants to get bloodwork and x-rays that I feel aren’t necessary, my doctor is only open while I’m working and I don’t have time off to use, how many days of over-the-counter treatment should I try before considering a prescription strength medication instead?, the physician at an urgent care doesn’t know my history but they can see me within a few hours instead of weeks, etc. Unfortunately, we have all experienced at least one of these in the past and it has led us to make decisions that affects our health and well-being.

I believe strategies for PCPs consideration with the objective to increase patient visits, if not already, would be a concierge payment model that can address high-copayment issues. This could include a set pay per visit despite services rendered or multiple disease states assessed, or even a monthly subscription model. In addition, if office schedules are booked, consider a telemedicine or secure text model that allows people that have limited time throughout the day an opportunity to be seen at a location convenient for them from a tablet, computer, or smart phone. Revisit the idea of the alternative site and find out why patients are going there instead. Expanding “walk-in” calendar slots can keep patients loyal rather than only choosing to have appointment-based visits.

Preventive care, that keeps people healthy at home and work, may be the best long-term strategy due to value-based payment and reimbursement that’s partially tied to outcomes metrics.1 It is vital to stress the importance of self-care along with primary care. I encourage practices to empower health consumers, so they are in the driver’s seat to their pursuit of personal wellness, but you are there to support their needs. The offerings should be co-designed by patients and clinicians under a new health ecosystem of service offerings.1 The growth of retail health sites is a positive sign that health consumers are looking for treatment, and our education and guidance can lead them to stay with or back to PCPs.