The Impact of Improving Access to Primary Care

Abstracts from the Kaiser Permanente2018 National Quality Conference


David Glass, PhD; Michael H Kanter, MD; Paul Minardi, MD

From Southern California

Background: There is a large body of literature that posits that many problems in the US health care system would be greatly ameliorated if primary care were more readily available to patients. However, there is little evidence about how quickly and how much utilization would shift and costs change if ready access to primary care were provided. This study fills that gap. It also offers some sobering lessons about challenges that may be encountered.
Methods: This study examines patterns of utilization and costs of employees and dependents at a large employer across an eight-year period, both before (2007-2009) and after (2010-2014) the implementation of a worksite medical office in 2010. The worksite office offered convenient primary care services with no travel from work (for employees), essentially guaranteed same-day access, and had no copay. Trends in all visit rates and costs were compared for the intervention group at the employer with a control group of Kaiser Permanente members who lived in the same area.
Results: The worksite medical office intervention group had an increase in primary care visits relative to the control group (+43% vs +4%, p < 0.001). This was accompanied by a reduction in urgent care visits by the intervention group compared with the control group (-43% vs -5%, p < 0.001). There were no statistically significant differences in the other types of visits, and the total visit costs for the intervention group increased 5.7% vs 2.7% for the control group (p = 0.008). A subgroup analysis of the intervention group (comparing dependents to employees) found that the dependents achieved a reduction in costs of 2.7% (p < 0.001) across the study period.
Discussion: Worksite medical offices offer an avenue for providing highly convenient primary care to employees and dependents of large employers. The potential for long-term reduction in utilization and costs with better access to primary care is significant, but not easily nor automatically achieved. Four years after the opening of a worksite medical office, we found members did rapidly and strongly shift towards greater use of primary care. However, the path to cost savings was uneven. There is a large opportunity to further test this approach as 78% of large employers do not have a worksite medical office.

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The Kaiser Permanente National CME Program designates this journal-based CME activity for 4 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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