Primary Care is designed to be the first place we start in our healthcare journey. However, many people end up foregoing their primary care visits, due to cost, time, priorities, life, etc. and end up in an emergency room or urgent care dealing with something that may have been avoided with ongoing or preventive health management. Let’s be clear: primary care is not the answer to all health problems. It is a forum we can leverage, however, to identify early onset conditions (even before they have materialized) to keep a better pulse of our health.
So, if primary care should be the first place we start for care – why aren’t these visits $0 across all health plans? There are of course plans out there that do have a $0 copay for visits, but it is not the majority. In the Kansas City individual market alone, only about 10% of plans have a $0 charge for primary care, and most of those are plans that come with higher premiums.
Let’s break this down to illustrate further the benefits for each participant:
Benefits to Offering $0 Primary Care Visits
For the Patient | For the Insurance Company | For the Provider | For the Employer |
$0 visits | Lowers claims costs by avoiding / minimizing unnecessary emergent care visits | Increases panel size and regular/predictable revenue stream from insurance company | Lowers claims costs by avoiding / minimizing unnecessary emergent care visits |
Establishes care / relationship with Provider | Able to identify high performing providers based on claims data, and therefore create high performance networks | Creates longevity and sustainability of practice with established patients filling majority of appointments | Retaining and attracting talent with better benefits design |
Lowers long-term medical costs by identifying and/or preventing chronic conditions with early intervention | Simplifies plan design and network strategy | Improves morale and engagement, reduces primary care provider shortage | Simplifies plan design |
With benefits across all participants, this is surely a no-brainer to implement. We are consistently promoting primary care to be the one-stop shop to direct and manage a patient’s care and if we truly believe this, then why not incentivize it with $0 visits?
Overutilization should not be of concern here, either. Most people do not choose to go to the doctor unless they have a problem. Even changing the perspective to truly leverage primary care as more of a preventative measure, the majority of people will only visit 1-3x per year, more if they are managing a chronic condition (as they do today).
Primary care doctors are experiencing record levels of burnout, as the lowest paid provider across the medical field, and being expected to do more with less. If we want to attract and retain talent in the primary care space, we need to put our money where our mouth is and give them the resources to manage a patient’s care holistically. This also means that insurance companies need to provide a competitive and fair rate to compensate for these visits. Just because the visits are free to the patient, does not mean skimping on the provider’s reimbursement amounts.
Offering $0 visits would no doubt reduce the number of unnecessary emergency visits. One study done over 10 years ago found that more than 30% of emergency room visits were non-urgent. Assume that statistic is even higher now due to physician shortages and long appointment wait times. These visits can be more than 10-12 times higher than if the same service was provided in a non-emergent setting. This means that your insurance company and employer can pay less in claims and the patient and employer should not see the drastic increases in premiums year over year. (Should not is used liberally here, there are many reasons why premiums increase but this is a major driving factor).
So, what do you think? Should Primary Care visits be $0? Do you think this would change behavior? Would it reduce unnecessary emergency visits? Would it make people manage their health more proactively? Would love your feedback and perspectives in the comments. If you enjoyed reading this, please share with a colleague or friend!
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