Todd Shryock

A new study says the rising costs of health care are dissuading patient from seeking preventative care and may be driving membership in direct primary care practices.

, were assembled from published articles and studies, the U.S. Census, and two proprietary data sources – the Hint Health DPC Consumer Insight 

 and the Hint Health Database, which contains the largest dataset of information on the economics and development of 

According to the study, the high cost of care in the U.S. continues to negatively impact Americans, with 63% of private health care consumers ranking the cost of care as the most dissatisfying aspect of their current healthcare option.

At the same time, as insurance premiums rise, 

 membership costs have remained steady. From 2017 to 2020, the median annual price of an individual retail DPC membership changed only slightly, from $77 to $75. An employer-paid membership for a family of four remained $158 in 2021 despite employer-sponsored health insurance premiums reaching an all-time high the following year.

DPC memberships are seeing an average annual growth of 36%, reaching a total growth rate of 241% from 2017-2021.

“More than half of private health care consumers ranked the cost of care as the most dissatisfying aspect of their current healthcare option,” said Aimee Leidich, head of operations, Hint Health, in a statement. “Health care costs are steadily outpacing income growth and inflation. Alternatively, DPC memberships remain affordable with little of the price inflation seen elsewhere.”

Physicians also report better support in DPC, with greater autonomy, compensation, and enhanced engagement with their practice. As a result, the number of doctors involved in DPC has grown. From 2017-2021, the number of active DPC clinicians per 100,000 people increased 159% in comparison to only a 6% increase overall in primary care providers per 100,000 peoplet.

Practices involved in a DPC network also saw growing membership, with affiliated practices seeing 402% growth in active members after three years compared to 27% for non-affiliated practices.

“From the data presented, it’s clear the fee-for-service care model is not an effective pathway to resolve our health system’s greatest challenges for cutting costs,” said Zak Holdsworth, CEO and co-founder, Hint Health, in a statement. “Working to eliminate preventative care services will only increase the number of costly chronic conditions down the road. Clinicians and employers are seeing the impact of the movement to do right by the whole system.”

This article originally appeared on Medical Economics®. 

Articles

Study shows most consumers dissatisfied with the cost of care.

High cost of health care may be boosting direct primary care membership

 that tracks the use of medicines in the United States shows that spending on prescriptions rose 12% in 2021 primarily due to COVID-19 vaccines and therapies.

, found that despite an increase in overall spending, costs per prescription on average were flat or slightly declining.

 use reached 194 billion daily doses in 2021, a record compared to the slowdown that occurred in 2020. In addition, health services utilization rates returned to pre-pandemic levels, but have not made up for the backlog of missed patient visits, preventive screenings, and elective procedures.

 were the least affected during the pandemic and have increased to higher than pre-pandemic levels, but is 3% lower still than projected in prior years. Screening and diagnostic tests have mostly rebounded to pre-pandemic levels as well, but the cumulative deficit is 5% below baseline with a large portion (41%) of that occurring between March and May of 2020.

Despite lags in doctor visits, the use of medicines has grown 9.6% over the last five years, according to the study. Retail drugs make up 86% of that, with the other 14% of use in non-retail settings, which continues to decline since 2017. Drugs dispensed from retail pharmacies has continued to grow 2.3% annually.

Medicine cost continues to be a significant burden for some patients. Out-of-pocket costs rose $4 billion in 2021 to $79 billion. This growth was driven by retail out-of-pocket costs, which grew 4.8% in 2021 following two years of declines and lower growth. Non-retail out-of-pocket costs have remained relative stable over the last four years, but have grown 16% since 2016.

COVID-19 vaccines and therapies were the main drivers.

Prescription spending rose 12% in 2021

 announced that is it providing nearly $90 million in American Rescue Plan funding to fund new data-driven efforts for HRSA Health Center Program-supported and HRSA-designated health centers to identify and reduce health disparities.

The data collection and reporting initiative is designed to collect more and better data on social determinants of health, while also streamlining and improving data quality reporting for health centers. This program will enable health centers to tailor their efforts to improve health outcomes and advance health equity, more precisely targeting the needs of specific communities or patients.

“Health centers are vital to increasing equitable access to primary health care,” said 

 Secretary Xavier Becerra, in a statement. He added that the plan will further enable health centers to utilize data to meet the needs of their community and help reduce gaps in care.

 has supported our nation’s health centers in becoming leaders in leveraging the latest technology and data to provide high-quality care to individuals and communities who have been historically underserved,” said HRSA Administrator Carole Johnson, in a statement. “Today’s announcement builds on this work and will help health centers modernize their data tools to improve equitable access to care and continue to best meet the needs of the communities and patients they serve.”

The funding can be used for various COVID-19 activities and for modifying, enhancing, and expanding health care services and infrastructure by improving health information technology, enhancing data collection, and supporting related staff training. These efforts will advance broader COVID-19 response, mitigation, and recovery efforts. Additionally, they will help prepare for future public health emergencies.

The enhancements that health centers may make to their infrastructure using the funds will support patient-level reporting and enable them to better identify, measure, and investigate disparities in health care use and health outcomes by race, ethnicity, age, and other important demographic factors, and to more precisely target their resources accordingly. Standardization of patient-level health data will enable the identification of populations most at risk for health disparities and will provide data to inform potential clinical interventions. Furthermore, the ability to collect, house, and report standardized patient-level health data will support health centers’ participation in critical population health surveillance activities during public health emergencies.

HRSA-supported health centers serve medically underserved populations and communities, which are often disproportionately affected by COVID-19. 

 serve 1 in 5 people living in rural communities, and 1 in 11 people nationwide. More than 90% of HRSA-funded health center patients are individuals or families living at or below 200% of the Federal Poverty Guidelines, and nearly 63% are racial or ethnic minorities.

Funds will aid HRSA Health Center Program-supported centers to identify and reduce health disparities.

HHS commits $90 million for data-driven approaches to reduce health disparities

Medicare has been pushing for better quality and lower costs for the past 10 years by encouraging health care providers to join Accountable Care Organizations. The result today is that ACOs coordinate the care of 11 million people, most with traditional 

 coverage. ACOs receive financial incentives for improving the health outcomes of their patients.

Despite showing improvement, these improved outcomes have not reached all older Americans equally. ACOs that include a higher percentage of patients who are Black, Hispanic, Native American, or Asian have lagged behind those with higher percentage of white patients in providing preventive care and keeping patients out of the hospital.

A study from the University of Michigan shows that 

some of this inequity stems from how an ACO’s patients get their primary care

. Even if they see specialist physicians who belong to an ACO, older adults aren’t required to see a primary care provider who belongs to the same ACO. The results were presented in the 

The study shows that ACOs with higher percentages of members of racial and ethnic minority groups also tended to have higher percentages of out-of-network primary care. That meant the patient’s routine care was delivered by a provider with no connection to the ACO, and therefore no potential financial benefit if they hit the quality benchmarks.

The study used data from nearly four million Medicare participants whose providers belong to 538 ACOs in the Shared Savings Program. The percentage of patients who got their primary care outside the ACO was nearly 13% in the ACOs that had the highest percentage of participants from racial or ethnic minorities, compared with about 10% of the patients in the other ACOs.

But even when the researchers left out the ACOs that had the highest percentage of out-of-network primary care, they still saw differences in quality of care. Older adults in ACOs with the highest percentages of minority participants were less likely to get diabetes and cholesterol checks, and those who had been hospitalized were more likely to end up back in the hospital within a month.

On the other hand, in the ACOs that had the lowest percentage of patients who got their primary care out of the ACO network, there were no differences in quality performance between ACOs with different percentages of members from minority groups.

The authors concluded that organizational efforts to increase in-network primary care at ACOs serving more patients of racial and ethnic minority groups could serve as a tangible, accessible corrective for reducing health care disparities.

According to the report, there are numerous ways in which ACOs serving more patients of racial and ethnic minority groups could do this. For example, they could offer after-hours and weekend access to medical services for beneficiaries, which has been shown to improve care continuity and limit ED utilization and admissions for ambulatory care–sensitive conditions. Alternatively, ACOs serving more patients of racial and ethnic minority groups could use financial incentives, such as lower copayments, that encourage their assigned beneficiaries to see in-network primary care clinicians. Clearly, any of these efforts would need to be balanced with the preservation of patient choice, which is a defining characteristic of SSP ACOs.

The Centers for Medicare and Medicaid Services, the federal agency that oversees Medicare and the ACO program, recently announced a 

 kind of ACO that will launch in 2023, called 

. It specifically focuses on health equity and bringing the benefits of the ACO model to underserved communities.

This article was originally published on Medical Economics®. 

Coordination and access to primary care within a network proves vital.

Study finds possible cause of racial and ethnic gaps in Medicare’s quality program

 of more than 125,000 health care workers found that physicians and long-term care workers saw an upward trend in turnover rates. Health care workers employed as aides and assistants had persistently high turnover rates and were experiencing a slow recovery. The study was published on 

Researchers found a four-fold difference in 

 rates between physicians and health aides or assistants. Rates were also higher for health workers with children under five for both sexes and highest among women. By race and ethnicity, persistently higher turnover rates were found among American Indian/Alaska Native/Pacific Islander workers; White workers had persistently lower rates; and Black and Latino workers experienced the slowest job recovery rates.

Throughout the study period, health care workers in 

 were less likely to turn over than workers in other settings.

Turnover rates varied widely across health care occupations with a nearly four-fold difference between jobs associated with lower wages (eg, aides/assistants) compared with higher wages (eg, physicians). Health aides and assistants had the highest turnover rates throughout the study period. Despite low overall turnover rates, physicians were the only occupational group to see continuous turnover increases over time.

Employment turnover among nearly all segments of the health care workforce has not yet fully recovered from the COVID-19 pandemic, with turnover rates among LTC workers and physicians worsening over time.

Turnover rates were mostly driven by exits from the labor force rather than unemployment. The underlying reasons for why an individual becomes unemployed versus leaving the labor force warrants attention. Being unemployed suggests that individuals are still seeking work, while those who exit the labor force are not, likely because of the availability of other resources (eg, working spouse) to sustain household income. For those exiting the labor force, further work is needed to understand whether workers are involuntarily leaving their jobs and may be marginally attached workers who would like a job only if the circumstances are right.

Researchers say the study suggests that although much of the health care workforce is on track to recover to prepandemic turnover rates, these rates have been persistently high and slow to recover among long-term care workers, health aides and assistants, workers of minoritized racial and ethnic groups, and women with young children. Given the high demand for long-term care workers, targeted attention is needed to recruit job-seeking health care workers and to retain those currently in these jobs to lessen turnover.

A recent investigation examined who was leaving health care.

Who is leading the health care exodus?

 of 1,000 U.S. adults with health care insurance with either a flexible spending account or health savings account showed that while those that use their benefits are generally happy, a lot of them who don’t are not.

The survey by First Dollar, a health care technology company, revealed a gap between those who understand their benefits and those who do no.

Many patients (42%) said that there were too many benefits to keep track of, 37% didn’t know where to find information about their benefits, and 32% said that they did not have time to look into all their benefits.

Of those unsatisfied with their health plan overall, 75% said they struggle to track benefits, 60% said they don’t use all of their benefits, and 48% said they just don’t know what their benefits are.

 CEO Jason Bornhorst said in a statement, “Most health insurance companies are doing the absolute minimum to educate customers and offer a streamlined solution.”

Members with a negative opinion about their 

 struggle to track their benefits, with three in four detractors strongly or somewhat agreeing that they cannot keep track of their benefits.

When members call their health plan providers to learn more about their plans, they typically ask questions about coverage (51%), bills (39%), out-of-pocket 

 (38%), and finding a provider (33%). In other words, they are calling to learn how their benefits work.

In fact, trying to navigate a health plan made most members “feel dumb,” with 24% strongly agreeing and 41% somewhat agreeing.

Patients often don’t know where to find information on their benefits or don’t have time to do so.