Impact of more primary care visits on commercial health care costs.

Objective:  To evaluate the relationship between the frequency of routine primary care visits and total health care expenditures among commercially insured adults.

Study design:  Retrospective cross-sectional statistical analysis of a nationally representative data set of health care utilization and expenditures over a 2-year period.

Methods: We used multivariate regression analysis to evaluate the association between the annualized number of visits with a primary care physician for routine care and total health care expenditures for commercially insured adults younger than 65 years, adjusting for underlying clinical complexity measured through risk scoring. Data were drawn from information collected by the Agency for Healthcare Research and Quality between 2021 and 2022.

Results: For a sample cohort of 3879 participants, more frequent primary care visits were associated with incremental reductions in expenditures only for participants with high underlying clinical complexity. A relative risk level of approximately 2 times the average commercially insured adult was identified as an inflection point, above which cost reductions vs counterfactual prediction were observed, up to a limited number of visits.

Conclusions:  Our results show a relationship between primary care visit frequency and health care expenditures with similar directionality and risk dependency as has been observed in other studies for Medicare-insured adults. This finding suggests that certain commercial populations may benefit from risk-stratified, high-touch primary care models like those being employed for some Medicare populations. The health care cost reduction benefits of these models appear premised more on clinical need than coverage type. Demonstrating this relationship is useful for health care providers, insurers, and policy makers who are developing advanced primary care models.