There is a good story to tell about using more primary care providers (PCPs). They are fairly low cost providers who can provide a lot of touches to patients with chronic conditions. These frequent, low cost touches should allow chronic conditions to be managed more effectively. The relationship and trust built will lead patients to head to their PCPs instead of the emergency room. Everyone is healthier and the total cost of care decreases.
This is a great story.
It is increasingly looking like it is not a true story.
A new study from Virginia is being discussed in an NBER working paper:
We conducted a randomized controlled trial, enrolling low-income uninsured adults to determine whether cash incentives are effective at encouraging a primary care provider (PCP) visit, and at lowering utilization and spending. Subjects were randomized to four groups: untreated controls, and one of three incentive arms with incentives of $0, $25, or $50 for visiting a PCP within six months of group assignment. Compared to the untreated controls, subjects in the incentive groups were more likely to have a PCP visit in the initial six months. They had fewer ED visits in the subsequent six months, but outpatient visits did not decline. We also used the exogenous variation generated by the experiment to obtain causal evidence on the effects of a PCP visit. We observed modest reductions in emergency department use and increased outpatient use, but no reductions in overall spending.
This is strong evidence. It is in an randomized control trial. It is a study where the study population is prone to have avoidable emergency room visits and non-regualr care. Everything is set up to see significant impacts of PCP care coordination.
And then nothing much.
This is important. The PCP care coordination story is a story that sounds good. It sounds plausible. And we have been investing a tremendous amount of time, effort and intellectual firepower into encouraging more primary care coordination.
And the evidence is shaky. It is either not there, or it is just bloop singles.