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. 2020 Apr 1;3(4):e203803.
doi: 10.1001/jamanetworkopen.2020.3803.

Utilization and Cost of an Employer-Sponsored Comprehensive Primary Care Delivery Model

Sanjay Basu  1   2   3 , Tyler Zhang  4 , Alli Gilmore  5 , Esha Datta  5 , Eun Yeong Kim  6
Affiliations

Utilization and Cost of an Employer-Sponsored Comprehensive Primary Care Delivery Model

Sanjay Basu et al. JAMA Netw Open. .

Abstract

Importance: Primary care is increasingly delivered at or near workplaces, yet utilization and cost of employer-sponsored primary care services remain unknown.

Objective: To compare the health care utilization and cost of an employer-sponsored on-site, near-site, and virtual comprehensive primary care service delivery model with those of traditional community-based primary care.

Design, setting, and participants: This population-based cohort study of 23 518 commercially insured employees and dependents of an engineering and manufacturing firm headquartered in southern California was performed from January 1, 2016, to July 1, 2019. A subset of the population with most (≥50%) primary care visits through employer-sponsored on-site, near-site, or virtual care clinics was matched to a subset not having most such visits through the employer-sponsored clinics using propensity score matching (n = 1983 each). In sensitivity analyses, employees were matched to dependents at neighboring firms that lacked access to the employer-sponsored primary care delivery model (additional n = 1680).

Exposures: Integrated primary care, mental health, and physical therapy delivered through on-site, near-site, and virtual clinics.

Main outcomes and measures: Utilization (inpatient, outpatient, emergency department, pharmaceutical, radiology, and laboratory visits per 1000 member-months) and spending (2019 costs per member per month in US dollars) by service type.

Results: A total of 23 518 individuals (mean [SD] age, 27 [15] years; 14 604 [62.1%] male) were included in the full population sample and had been enrolled in the employer-sponsored health plan for a mean of 29 months (interquartile range, 14-48 months). Of eligible members, 5292 (22.5%) used the employer-sponsored services, with 2305 (9.8%) using them for most of their primary care. The mean (SD) cost of employer-sponsored service delivery was $87 ($32) per member month. Among the matched populations (mean [SD] age, 31 [11] years; 3349 [84.5%] male) of primary users vs control individuals, total spending was 45% lower per member per month (95% CI, 35%-55%; cost difference, -$167 per member per month; 95% CI, -$204 to -$130; P < .001) among users after adjustment. The lower spending was associated with lower spending on non-primary care services, such as emergency department (-33%; 95% CI, -44% to -22%) and hospital visits (-16%; 95% CI, -22% to -10%), despite higher spending on primary care (109%; 95% CI, 102%-116%) and mental health (20%; 95% CI, 13%-27%).

Conclusions and relevance: The findings suggest that individuals who used the models' services for most of their primary care had lower total spending despite higher primary care spending, which may be associated with self-selection of lower-risk persons to the employer-sponsored services and/or with the use of comprehensive primary care.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Basu reported receiving personal fees from Collective Health during the conduct of the study and grants from the National Institutes of Health, Centers for Disease Control and Prevention, US Department of Agriculture's Economic Research Service, Center for Poverty Research, Robert Wood Johnson Foundation, Harvard University, and Stanford University and personal fees from KPMG, Research Triangle Institute, PLOS Medicine, and The New England Journal of Medicine outside the submitted work. Dr Zhang reported being employed with 1Life Healthcare Inc, the administrative and managerial services company for the affiliated One Medical physician-owned professional corporations. 1Life Healthcare Inc and the One Medical entities do business under the One Medical brand and provide services to the employer studied in the journal article submission. Dr Gilmore reported receiving personal fees from 1Life Healthcare Inc during the research period and being employed by 1Life Healthcare Inc, the administrative and managerial services company for the affiliated One Medical physician-owned professional corporations. Dr Datta reported receiving personal fees from One Medical and being employed by One Medical during the conduct of the study and being employed by 1Life Healthcare Inc, the administrative and managerial services company for the affiliated One Medical physician owned professional corporations. Ms Kim reports being employed by SpaceX, the employer studied in this article, during the conduct of the study and receiving personal fees from Collective Health. No other disclosures were reported.

Figures

Figure.
Figure.. Relative Differences in Spending, Utilization, and Spending per Encounter Based on Multivariable-Adjusted Regressions After Propensity Score Matching
Percentage of differences in spending (US $2019) per member per month (A), percentage differences in utilization (encounters per 1000 member-months) by place of service and type of practitioner (B), and percentage differences in spending per encounter (2019 US dollars per encounter) by place of service and type of practitioner among those most commonly using subsidized on-site or near-site clinics for primary care compared with those most commonly using unsubsidized off-site clinics (C). Error bars indicate 95% CIs from multivariable regressions among matched cohorts adjusted for age, sex, risk score, home zip code, enrollment duration, and modal Clinical Classifications Software diagnosis category.
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