Why Primary Care Should Pay Attention to Continuity of Care

Reducing healthcare costs through better care delivery begs the question: “Where do we start?” When the goal includes something to the effect of “the greatest possible improvement for a population,” it is good to reflect on the body of evidence pointing to high performing population health outcomes. The work of Starfield and others is instructive: High performing health systems have high performing primary care as their foundation. High performing primary care has four cardinal features:¹

• First point of access
• Person-focused relationship over time
• Coordination across the continuum of care
• Provides comprehensive services

A recent piece on continuity of care in Medicare reiterates this case. Medicare beneficiaries with better continuity of care are less likely to undergo unnecessary procedures.² This is consistent with another study looking at the relationship between continuity of care and hospitalization, ED use and complications in Medicare beneficiaries with chronic conditions. They found a 4-6% lower total cost of care with better continuity of care. 

Continuity of care is a proxy for Starfield’s “person-focused relationship over time.” We can measure this with claims data using the Bice-Boxerman index (the measure used in these studies).⁴ The choice of metrics matters because metrics drive work--but primary care is inundated with metrics. When considering the relative value of metrics, it would be reasonable to consider continuity of care as one that reflects a core attribute of high-performing primary care and is linked to important outcomes.

L. Gordon Moore, MD, is senior medical director for populations and payment solutions at Solventum.

¹Macinko, James, Barbara Starfield, and Leiyu Shi. “Quantifying the Health Benefits of Primary Care Physician Supply in the United States.” International Journal of Health Services: Planning, Administration, Evaluation 37, no. 1 (2007): 111–26. ²Romano MJ, Segal JB, and Pollack C. “The Association between Continuity of Care and the Overuse of Medical Procedures.” JAMA Internal Medicine, May 18, 2015. doi:10.1001/jamainternmed.2015.1340. ³Hussey PS, Schneider EC, Rudin RS, Fox D, Lai J, and Pollack C. “Continuity and the Costs of Care for Chronic Disease.” JAMA Internal Medicine 174, no. 5 (May 1, 2014): 742–48. doi:10.1001/jamainternmed.2014.245. ⁴Bice, T. W., and S. B. Boxerman. “A Quantitative Measure of Continuity of Care.” Medical Care 15, no. 4 (April 1977): 347–49.