How Primary Care Can Help Lower Healthcare Costs

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As the price of just about everything has been increasing, the rising cost of healthcare services has been and continues to be a challenge for many families. Two in five Bay Staters – 41 percent – struggled to pay for healthcare services in 2021, according to the Center for Health Information and Analysis. Our state has struggled to contain healthcare cost growth over the last decade due to escalating prices, and employers project their healthcare-related costs to increase again next year by at least 6 percent, according to Willis Towers Watson.

As the leader of a health benefits company in Massachusetts and someone who has worked in the healthcare sector for over two decades, I strongly believe that enhancing access to primary care is important to improving whole health and lowering the annual rate of growth in healthcare costs.

The case for primary care
Whole health is not only about your physical health, but the behavioral, emotional, and social factors that affect your overall well-being. Non-clinical factors like access to nutritious food and reliable transportation, personal finances, and social isolation can determine up to 80 percent of health outcomes. Primary care physicians (PCPs) are well positioned to help their patients better understand and manage such drivers of health – think of them as the quarterbacks of healthcare.

PCPs are equipped to empower us in our health journey, manage chronic conditions, and coordinate care to ensure tests aren’t needlessly repeated and medicines work effectively. They can also screen for mental health conditions like anxiety and depression and provide treatment or refer patients to therapists.

Studies have shown that people who have a relationship with a trusted PCP are more likely to have higher satisfaction with the healthcare system and are less likely to need care at an emergency room or through an acute hospital admission. However, while it’s encouraging that patients’ experience with their primary care practices improved in the last two years, according to a 2022 study by Massachusetts Health Quality Partners, we still have a ways to go to improve access to primary care. Here’s how we can all do our part to champion primary care.

Encourage the use of primary care
Health plans working closely with employers can empower employees and members to regularly visit a PCP. PCPs are critical to helping us stay healthy and heading off potential medical issues before they become severe – and costly. In 2021, the Massachusetts Health Policy Commission found that those who earn a lower income and went without needed care due to cost were twice as likely to have had a potentially avoidable emergency room visit. But alarmingly, studies show declining PCP use in recent years. We must work together to educate consumers about ways a PCP can help us achieve better health and curb issues before they become serious medical events.

Educate consumers about the right place to receive care
Choosing the right healthcare setting to receive care is an effective way for consumers to reduce their costs. One of the most significant and most avoidable out-of-pocket expenses for individuals is an emergency room (ER) visit for non-life-threatening events like a minor cut, earache, or allergies. With ER visits costing nearly 10 times compared to urgent care, they are an expensive place for non-emergency care. Consumer education about when to use the ER and other lower-cost care settings, including urgent care, primary care, 24/7 telehealth, nurse lines, and the use of remote monitoring technology, is critical to empowering consumers to leverage lower-cost healthcare settings.

Expand value-based payment models
Collaboration with providers is one of the ways that insurers can better manage costs while also improving healthcare for our members. Value-based care models reward doctors and other providers for efficiency, coordination, health outcomes, and care experience rather than on the volume of care provided under the traditional fee-for-service system. At UniCare, we are working to accelerate growth in value-based payment models, which are being embraced by Massachusetts providers because they align financial incentives with providers’ priority to provide better care, lower costs, and a better experience for their patients. More than 50 percent of UniCare’s members are patients of Massachusetts-based PCPs enrolled in these types of programs, and we are working with providers to increase that number because it ultimately means better access to healthcare and lower costs over time for everyone.

While primary care is not a panacea, it is a proven resource for better health at a lower cost. The more we work together to expand access to primary care, the more we can have a strong impact on improving whole health and keeping healthcare affordable in Massachusetts.

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David Morales is the general manager of UniCare, a health benefits company serving state and municipal employees, retirees, and their families insured through the Commonwealth of Massachusetts Group Insurance Commission. Learn more at unicaremass.com.

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