Physician Utilization by People with Chronic Conditions

December 2003 Physician Utilization by People with Chronic Conditions The majority of people with chronic conditions receive their health care coverage through employer-sponsored insurance (66 million out of 125 million people with chronic conditions in 2000) Eighty percent of all enrollees in a large employer-sponsored, fee for service health plan see a physician in a year Among enrollees with five or more chronic conditions, almost 100% see a physician and only about 25% see primary care practitioners for more than half their visits This analysis looks at the visit patterns to primary care physicians (PCPs) and specialists among enrollees who had at least one physician visit during 1999 Specialists Are the Most Common Provider Regardless of the number of chronic conditions, enrollees visit a specialist as often or more often than a primary care provider Enrollees with no chronic conditions have a comparable number of Figure 1: Average Num ber of Physician Visits, by Type and Num ber of Chronic Conditions 23.1 25 20 13.5 15 10.0 10 2.1 2.3 3.2 4.8 7.2 4.6 6.0 12.2 Number of C hronic C onditions Number of P C P Visits 100% 80% 60% 48.6% 40.0% 40% 38.1% 34.8% 31.0% 26.0% 20% 0% 5+ Number of C hronic C onditions In general, as the number of chronic conditions increase, the average number of physician visits increases but the percentage of enrollees who receive the majority of their care from a PCP declines (figure 2) Only enrollees with no chronic conditions are more likely to have a PCP visit (74%) than a specialist visit (66%) Specialists Are the Most Common Provider for Children with Two or More Chronic Conditions 90% of children who see physicians during the year have at least one PCP visit Children who have at least two chronic conditions see a specialist for the majority of their visits; children with at least five chronic conditions have 22% more specialist visits than PCP visits (figure 3) 7.7 Figure 3: Average Number of Physician Visits (Enrollees Ages 0-17), by Type and Num ber of Chronic Conditions 0 Figure 2: Percentage of Enrollees Who See a Prim ary Care Physician as Their Most Comm on Provider 5+ Number of S pec ialist Visits 30 25 17.4 20 14.2 10.8 15 10 PCP and specialist visits, whereas, enrollees with five or more chronic conditions have almost twice as many specialist visits as PCP visits (figure 1) 27.5 3.1 1.4 4.9 3.9 6.2 6.8 7.1 9.1 0 Number of Chronic Conditions Number of PCP Visits Number of Specialist Visits 5+ Figure 6: 7:Average Average Num Number of Physician Physician Visits Visits Figure ber of (Enrollees Ages Ages 45-54), 55-64), by by Type Type and and Num Number ber (Enrollees of Chronic Chronic Conditions Conditions of 25 22.8 21.8 20 15 10 5 1.7 1.62.7 9.4 8.6 5.3 5.4 6.8 6.2 4.1 4.2 4.7 4.4 3.0 2.9 12.9 11.8 10.9 11.3 6.7 6.9 0 0 Adults with Multiple Chronic Conditions Have Twice as Many Specialist Visits as Primary Visits Of adult enrollees, the percentage who have a PCP visit is similar to those who have a specialist visit during the year regardless of the number of chronic conditions For enrollees between the ages of 18 and 65 regardless of number of chronic conditions, fewer than 40% see a primary care provider for the majority of their physician visits Young adult enrollees (18-44) with multiple chronic conditions have twice as many specialist visits as PCP visits Older adults (45-64) with five or more chronic conditions have twice as many specialist visits as PCP visits Interestingly, enrollees who are 45 to 54 have fewer total physician visits than enrollees 18 to 34 (figures and 7) Figure 4: Average Num ber of Physician Visits (Enrollees Ages 18-34), by Type and Num ber of Chronic Conditions 30 27.4 25 16.9 20 8.4 10 12.1 11.8 15 1.72.6 5.5 2.9 4.2 5.7 Number of Chronic Conditions Number of PCP Visits 3 Number of Number of Chronic Chronic Conditions Conditions Number of Number of PCP PCP Visits Visits Figure 5: Average Num ber of Physician Visits (Enrollees Ages 35-44), by Type and Num ber of Chronic Conditions 30 26.8 25 20 15.0 15 10 1.62.8 5.3 2.9 7.7 4.3 10.6 5.7 12.5 7.7 0 Number of Chronic Conditions Number of PCP Visits Number of Specialist Visits 5+ 4 Number of Number of Specialist Specialist Visits Visits 5+ Number of Specialist Visits Enrollees Over 65 Also Visit a Specialist for the Majority of Their Visits Regardless of the number of chronic conditions, enrollees 65 and older see a specialist most often and have a higher average number of specialist visits than PCP visits The average number of primary or specialist physician visits is comparable across retiree age groups (65-74, 75-84, 85+) by number of chronic conditions (figures 8-10) 7.8 0 1 In fact, enrollees ages 65 and older with five or more chronic conditions have fewer specialist physician visits than children with five or more chronic conditions Enrollees that are 85 years or older have a similar average number of specialist physician visits as adults and slightly higher average PCP visits 5+ 5+ Conclusion With the exception of children with one or no chronic conditions, enrollees see a specialist physician more often than a primary care physician The greater the number of chronic conditions one has, the less likely one is to receive the majority of one’s care from a primary care practitioner This data suggests that the number of chronic conditions is a more important predictor of the type of physician used and number of physician visits than age Specialist providers are responsible for a significant portion of patient care, especially for those people with multiple chronic conditions Therefore, efforts to coordinate clinical care for people with multiple chronic conditions should clearly involve both primary care physicians and specialists to a significant degree Further consideration of using some specialties other than PCPs to coordinate care should be explored About Partnership for Solutions Partnership for Solutions, led by Johns Hopkins University and The Robert Wood Johnson Foundation, is an initiative to improve the care and quality of life for the estimated 125 million Americans with chronic health conditions The Partnership is engaged in three major activities: conducting original research and identifying existing research that clarifies the nature of the problem; communicating these research findings to policymakers, business leaders, health professionals, advocates, and others; and working with public and private programs to identify promising solutions to the problems faced by people with chronic conditions Figure 8: Average Num ber of Physician Visits (Enrollees Ages 65-74), by Type and Num ber of Chronic Conditions 30 20 10 1.82.8 3.14.8 7.1 4.4 9.7 5.7 Primary care physician (PCP) is defined as general practice, internal medicine, family practice, pediatrics, and geriatric medicine Data is from a national, employer-sponsored, fee for service health plan using 1999 claims and 11.6 0 Num ber of Chronic Conditions Num ber of PCP Visits 5+ Num ber of Specialist Visits includes claims for employees, retirees and dependents (2.9 million claims) Figure 9: Average Num ber of Physician Visits (Enrollees Ages 75-84), by Type and Num ber of Chronic Conditions 25 20 15 10 2.03.0 5.3 3.4 4.9 7.9 10.9 6.4 14.3 23.6 12.7 8.1 0 Num ber of Chronic Conditions Num ber of PCP Visits Figure 10: Average Num ber of Physician Visits (Enrollees Ages 85+), by Type and Num ber of Chronic Conditions 25 14.2 15 10 2.3 2.8 4.1 5.1 5.8 8.0 5+ Num ber of Specialist Visits 20 Analysis Information: 13.2 7.2 22.9 10.9 7.6 22.4 14.1 9.5 0 Num ber of Chronic Conditions Num ber of PCP Visits 5+ Num ber of Specialist Visits ... for those people with multiple chronic conditions Therefore, efforts to coordinate clinical care for people with multiple chronic conditions should clearly involve both primary care physicians... 85+) by number of chronic conditions (figures 8-10) 7.8 0 1 In fact, enrollees ages 65 and older with five or more chronic conditions have fewer specialist physician visits than children with. .. Num Number of Physician Physician Visits Visits Figure ber of (Enrollees Ages Ages 45-54), 55-64), by by Type Type and and Num Number ber (Enrollees of Chronic Chronic Conditions Conditions of