Objective To develop claims‐based measures of comprehensiveness of primary care physicians (PCPs) and summarize their associations with health care utilization and cost. Data Sources and Study Setting A total of 5359 PCPs caring for over 1 million Medicare fee‐for‐service beneficiaries from 1404 practices. Study Design We developed Medicare claims‐based measures of physician comprehensiveness (involvement in patient conditions and new problem management) and used a previously developed range of services measure. We analyzed the association of PCPs’ comprehensiveness in 2013 with their beneficiaries’ emergency department, hospitalizations rates, and ambulatory care‐sensitive condition (ACSC) admissions (each per 1000 beneficiaries per year), and Medicare expenditures (per beneficiary per month) in 2014, adjusting for beneficiary, physician, practice, and market characteristics, and clustering. Principal Findings Each measure varied across PCPs and had low correlation with the other measures—as intended, they capture different aspects of comprehensiveness. For patients whose PCPs’ comprehensiveness score was at the 75th vs 25th percentile (more vs less comprehensive), patients had lower service use (P < 0.05) in one or more measures: involvement with patient conditions: total Medicare expenditures, −$17.4 (−2.2 percent); hospitalizations, −5.5 (−1.9 percent); emergency department (ED) visits, −16.3 (−2.4 percent); new problem management: total Medicare expenditures, −$13.3 (−1.7 percent); hospitalizations, −7.0 (−2.4 percent); ED visits, −19.7 (−2.9 percent); range of services: ED visits, −17.1 (−2.5 percent). There were no significant associations between the comprehensiveness measures and ACSC admission rates. Conclusions These measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries of PCPs providing more comprehensive care had lower hospitalization rates, ED visits, and total Medicare expenditures.

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Objectives: To develop two practice-site-level measures of comprehensiveness and examine their associations with patient outcomes, and how their performance differs from physician-level measures.Data Sources: Medicare fee-for-service claims. Study Design:We calculated practice-site-level comprehensiveness measures (new problem management and involvement in patient conditions) across 5286 primary care physicians (PCPs) at 1339 practices in the Comprehensive Primary Care initiative evaluation in 2013. We assessed their associations with practices' attributed beneficiaries' 2014 total Medicare expenditures, hospitalization rates, ED visit rates. We also examined variation in PCPs' comprehensiveness across PCPs within practices versus between primary care practices. Finally, we compared associations of practice-site and PCP-level measures with outcomes.

Research Objective More comprehensive primary care is associated with lower costs and better outcomes for patients. Several primary care interventions under the ACA target practice site level redesign. Thus, it is helpful to have measures to assess whether the comprehensiveness of the practice site is associated with beneficiary outcomes. Building on prior work developing and validating primary care physician‐level measures of comprehensiveness, we developed two practice‐level measures of primary care comprehensiveness and tested their associations with beneficiary outcomes. Study Design Lagged analysis of claims‐based outcomes for Medicare FFS beneficiaries during a year to practice‐level comprehensiveness measures in the previous year. Data are from 2013‐2014 from the evaluation of the Comprehensive Primary Care Initiative. The practice‐level measures assessed, across all primary care physicians in a practice site, the extent to which the physicians in the practice were involved in care for their patients’ conditions (IPC = involved in patient conditions) and managed their patients’ new problems (NPM = new problem management). Regression models controlled for beneficiary, practice, and market characteristics. Population Studied 1,343 primary care practices where 5,336 physicians cared for over 1 million Medicare fee‐for‐service beneficiaries. Principal Findings The two measures varied across primary care practices and captured different aspects of comprehensiveness, as intended. Comparing practices in the 75th versus 25th percentile for each of these measures of comprehensiveness, practices where physicians had greater involvement in patient conditions (IPC) had 2.3% lower Medicare expenditures (P = .03), and 1.7% lower ED visit rates per 1000 beneficiaries (P = .08). Practices where physicians demonstrated greater new problem management (NPM) had 1.6% lower Medicare expenditures (P = .04), 1.8%, lower hospitalization rates per 1000 beneficiaries (P = .03), 2.6% lower overall ED visit rates (P = .00), and 2.6% lower ED outpatient visit rates (P = .01). Conclusions These measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries in primary care practices where physicians deliver more comprehensive care had slightly lower Medicare expenditures, and lower rates of hospitalizations, ED visits, and ED outpatient visits. Implications for Policy or Practice These new measures may be useful indicators of 2 aspects of practice‐level comprehensiveness (involvement in patient conditions and new problem management) for studies that target the practice as the unit of change. Additional research should focus on the robustness of these findings for the full Medicare population as well as for other populations. Future research to test interventions to promote primary care comprehensiveness may also be useful. Primary Funding Source Centers for Medicare and Medicaid Services.