This article investigates healthcare utilization differences for Traditional Medicare (TM) and Medicare Advantage (MA) patients under the care of primary care physicians (PCPs) who receive reimbursement from risk-bearing capitation contracts.
We compare counts of medical services between Medicare patients for a single coverage year for inpatient, outpatient, carrier, home health, skilled nursing, and emergency department facilities. We utilized differences of means t-tests and Poisson regression for the analysis.
After controlling for other factors, we find that Essence patients under the care of PCPs reimbursed more extensively through risk-bearing capitation arrangements received dramatically fewer medical services in all treatment venues than traditional Medicare patients under the care of PCPs without capitated reimbursement. Specifically, they received 60.7% fewer inpatient days, 71.9% fewer outpatient visits, and 51.8% fewer emergency department visits. Furthermore, they received 47.9% more medical procedures from a PCP. Thus, they were treated in less costly venues.
Longitudinal analysis is needed, but if this phenomenon persists with no long-term adverse effects on patients and the medical providers, capitated reimbursement for primary care could produce the desired outcomes of value-based care reimbursement mechanisms.
This research is unique in that it evaluates annual healthcare utilization based on the risk-bearing capitated reimbursement for patients' PCPs. Other research has not found a strong correlation between value-based reimbursement, healthcare utilization, and cost savings. This article demonstrates significantly less healthcare utilization for patients when PCPs receive greater risk-bearing capitated reimbursement. However, services received from a PCP were greater for these patients.
