The Value of Relationships in Healthcare

Changes in Health Care Use and Outcomes After Turnover in Primary Care

“…Patients’ potential loss of a PCP will become more relevant as an increasing number of PCPs near retirement; since 1975, the number of practicing physicians older than 65 years has increased by more than 274% . Disruptions to patients’ primary care may be particularly relevant for patients of physicians in solo practice: such patients may face larger barriers to reestablishing care once their PCP exits the workforce because they are less likely to have preexisting relationships with other PCPs at the clinic …”

Breadth and Exclusivity of Hospital and Physician Networks in US Insurance Markets

“…In insurance markets characterized by churn, a concern is that individuals changing insurance plans must make difficult choices regarding affording and maintaining preferred clinical relationships on the one hand and establishing new in-network relationships on the other. This concern is motivated by research documenting noteworthy disruptions in care and an increased reliance on emergency departments associated with changes in insurance plans . Narrow network plans have also been shown to have lower premiums, yet little is known about whether selection of a less expensive, narrow network plan increases the likelihood that patients would need to find new clinicians once they enroll.…”

“…This concern is motivated by research documenting noteworthy disruptions in care and an increased reliance on emergency departments associated with changes in insurance plans. [13][14][15][16] Narrow network plans have also been shown to have lower premiums, 30 yet little is known about whether selection of a less expensive, narrow network plan increases the likelihood that patients would need to find new clinicians once they enroll. Finally, the patient financial protections established by the Patient Protection and Affordable Care Act-such as annual limits on patient out-of-pocket spending and prohibitions on annual and lifetime insurer spending maximums-apply to nearly all private health insurance plans but only for care received by in-network clinicians and hospitals.…”

“…Insurance plan changes decrease the likelihood of establishing a durable primary care relationship, decrease rates of chronic disease control, increase reliance on subspecialists for primary care services, and are associated with greater use of emergency departments. [13][14][15][16] Given that the risk of care disruptions is higher for beneficiaries in a plan with a narrow network or with a network of physicians who are not likely to be found in other plans, understanding networks along these domains is critical to evaluating their implications for care continuity. While the breadth of networks has been documented in the individually purchased insurance market, 4,5,17 a more holistic picture of networks is needed to understand implications for care continuity because switching between insurance plans not only occurs within an insurance type but between them.…”

“…With frequent churn occurring when patients change insurance plans, insurance network design may have implications for the extent to which churn disrupts the continuity of care. Insurance plan changes decrease the likelihood of establishing a durable primary care relationship, decrease rates of chronic disease control, increase reliance on subspecialists for primary care services, and are associated with greater use of emergency departments …”