Research Activities, May 2013
Patients who move among medical groups have higher care costs and use than those who stay in the same group
Large medical groups are often responsible for providing medical care to members of health care plans. Belonging to the same medical group over time improves continuity of care. In fact, a new study found that individuals who moved among medical groups had higher health care costs and greater use of inpatient and emergency care than those who did not.
Researchers analyzed claims data on 121,780 patients enrolled in a large nonprofit statewide health plan from 2005 to 2009. A patient’s medical group was where they received the greatest number of primary care visits each year regardless of the number of providers seen. Patients were classified as high continuity if they stayed in the same medical group.
Within the study population, 4 percent of patients were never attributable to a medical group during the 5 years. These tended to be younger, male, and less likely to have chronic conditions. The majority of patients (84 percent) were attributed to a medical group in 3 or more years. These patients tended to be older, female, have a high prevalence of chronic conditions, and to be covered by Medicare. Most of this group was also classified as having high continuity, that is, they stayed in the same medical group for all years. High-continuity patients had more coexisting conditions and older age than patients considered to have medium or low continuity. Patients with high medical group continuity also had a lower probability of having any inpatient expenditure or emergency department use. They also had lower total medical costs. Medium- and low-continuity patients had 9 percent to 18 percent higher total costs of care compared to high-continuity patients, most likely from their increased use of emergency departments and inpatient hospitalizations. The study was supported by AHRQ (Contract No. 290-07-10010).
See "Patient medical group continuity and healthcare utilization," by Louise H. Anderson, Ph.D., Thomas J. Flottemesch, Ph.D., Patricia Fontaine, M.D., M.S., and others in the August 2012 American Journal of Managed Care 18(8), pp. 450-457.