The Office of Health Strategy (OHS) and their consultants have asserted that it is critical to double spending on primary care in Connecticut to lower skyrocketing total healthcare costs. It’s very appealing to think that increasing investments in prevention and care management will reduce total costs. It avoids the difficult work of getting large health systems and drug companies to lower their extreme prices. But unfortunately, there is no evidence to support the idea.
Under an Executive Order from 2020, OHS has promoted a controversial plan to double primary care spending in order to control total healthcare costs in Connecticut. We estimate that under their plan, primary care spending would rise an extra $3.9 billion in Connecticut by 2025, when fully implemented. OHS is now asking the legislature to codify their plan in HB 5042, An Act Concerning Health Care Cost Growth.
Primary care is the majority of healthcare visits. It includes checkups and screenings, minor illnesses and injuries, and managing chronic conditions. Robust primary care can prevent downstream health problems, reduce specialty care, keep people out of the hospital, and improve overall health outcomes. But in numerous trials, investment in primary care hasn’t saved more than it costs.
It is true that healthier communities and countries with lower total spending usually spend more on primary care and less on specialty and facility care. But correlation is not causation. For example, the incidence of shark attacks correlates tightly with ice cream consumption. Hot summer days drive ice cream sales up and more of us go to the beach and swim in the ocean. We can’t reduce shark attacks by eating less ice cream.
Medicare tried investing in primary care to lower overall costs, without success. Under the Comprehensive Primary Care program, 502 primary care practices were paid to coordinate care for 565,674 beneficiaries over three years. While emergency department visits went down, those savings didn’t cover the extra primary care spending, costing Medicare millions more dollars.
A program that offered intensive primary care for high-need veterans improved patient satisfaction but did nothing to change hospital or emergency department use and didn’t save money. A program that paid uninsured adults in Virginia for primary care visits got patients to visit their doctor, but failed to save money.
OHS has cited Rhode Island’s experience as evidence that increasing primary care spending in the state lowered overall costs. But in addition to increasing primary care spending, Rhode Island simultaneously implemented other important cost control policies. It’s likely their price caps on services made the difference, as prices for care dropped but both inpatient and outpatient visits didn’t change. We’d have expected utilization of services to drop if primary care providers were keeping people out of the hospital and specialists’ offices.
OHS’s plan to increase the pay of primary care physicians to encourage more medical students to choose primary care is also unlikely to help. Areas of the US with more primary care physicians don’t experience lower spending growth.
There is a growing consensus that to lower healthcare costs and insurance premiums, we must address the drivers of rising costs – prices for drugs and prices for care at large, monopoly health systems in our state. OHS’s analyses of Connecticut’s healthcare spending has confirmed this. We have to get serious about lowering those prices, despite the considerable political power of these industries. Supporting primary care is a good thing, but it won’t save money.