A new Health Services Research study by Mathematica’s experts sheds light on how a large-scale, multipayer primary care redesign—the Comprehensive Primary Care (CPC) initiative—reduced growth in all-cause emergency department (ED) visits. “Our results suggest that greater access to the primary care practice and more effective primary care both contributed to lower growth in ED and urgent care visits during the initiative,” said Lori Timmins, senior researcher at Mathematica and lead author on the paper. “These findings also suggest that new approaches to payment for and the delivery of primary care in large-scale primary care redesign initiatives can lead to meaningful reductions in ED and urgent care visits.”
The CPC initiative was one of the largest efforts by the Centers for Medicare & Medicaid Services, in collaboration with 39 private and public payers, to strengthen primary care in nearly 500 practices. A previous Mathematica-led analysis found that CPC was associated with lower growth in ED visits. However, the types of ED use that drove this result, and the association between CPC and urgent care visits, remained a black box.
In this new study, Mathematica’s researchers examined the types of ED and urgent care visits that drove the overall trends. They found that CPC reduced growth in outpatient ED and urgent care visits, which was driven by slower growth in weekday visits to the ED or the urgent care center for visits that might have been substituted with visits to a primary care provider.
Specifically, the study found the following:
- CPC practices had 2 percent lower growth in all-cause ED visits than comparison practices.
- CPC practices had 3 percent lower growth in weekday visits to the ED for visits that could have been substituted (that is, treated) by a visit to the primary care provider.
- There was 3 percent lower growth in ED visits that could potentially have been prevented with quality primary care, with no difference between weekdays and non-weekdays.
- Urgent care visits had 9 percent lower growth for both all-cause visits and for those visits that could have been substituted with visits to a primary care provider.
This study was selected as among the best of the AcademyHealth 2020 Annual Research Meeting, demonstrating that Mathematica’s seasoned experts continue to lead research and provide evidence on primary care transformation to support a national shift in care delivery. Increasingly, payers, practitioners, and policymakers agree on the need to strengthen primary care to forge a path to progress in improving health care and reducing costs. Primary care delivery has the potential to shape ED and urgent care center use. The findings from the Mathematica study provide compelling evidence that, indeed, primary care plays an important role in shaping acute service use and containing health care costs.