Optimal Number of Primary Care Visits?


Optimal Number of Primary Care VisitsIntroduction

With the increasing interest in learning how to improve the use of primary care, we have modeled the optimal number of annual primary care visits related to health plan costs as shown in the graph below. Increasing primary care is a key element in the HCMS Aligned Incentives Health Plan as described in our webinar series (please click on these links to view the first and second webinar recordings in our healthcare reform series).


This model was made possible by the use of our Health as Human Capital Research Reference Database (RRDb) which includes comprehensive, whole-person data on over 3.5 million de-identified people. The study focuses on the high-risk 5% population which incurs 50% or more of health plan costs.

The Optimal Number of Primary Care Visits for High-Risk Groups

Optimal Number of Primary Care Visits

The Results

There is a statistically-significant relationship between annual health benefit costs and annual primary care visits per individual. A downward cost trend is seen between one, two, and three primary care visits per year. This shows the importance of primary care access in managing health benefit costs and particularly for the 5% high-risk individuals.


The HCMS Aligned Incentives Health Plan includes three to four free primary care visits as an incentive for patients to use primary care. It also provides incentive-based reimbursement for primary care providers to provide access to primary care. This plan encourages primary care from both a patient and provider perspective in order to ensure whole-person care and prevent any continuation of high-risk/high-cost episodes.


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