Continuity of care: Is it cost effective?

Objective: To examine the association between the degree of healthcare prov ider continuity and healthcare utilization and costs. Study Design: A longitudinal, prospective, observational study. Patients and Methods: Data on patients with arthritis, asthma, epigastric p ain/peptic ulcer disease, hypertension, and otitis media were collected at each of 6 health maintenance organizations (HMOs). Outcome variables includ ed the number of prescriptions for the target disease and the cost, total n umber of prescriptions and the cost, the number of outpatient visits, and t he number of hospital admissions. Disease-specific severity of illness, typ e of visit, and provider information were obtained at each encounter. HMO p rofit status, visit copay, gatekeeper strictness, formulary limitations, us e of multisource (generic) drugs, gender, number of months in the study, ag e, and severity of illness were controlled in the analyses. Results: There were 12,997 patients followed for more than 99,000 outpatien t visits, 1000 hospitalizations, and more than 240,000 prescriptions. incre asing the number of primary or specialty care providers a patient encounter ed during the study generally was associated with increased utilization and costs when HMO and patient characteristics were controlled. The number of specialty care providers also increased as the number of primary care provi ders increased. The incremental increase in pharmacy costs per patient per year with each additional provider ranged between $19 in subjects with otit is media to $58 in subjects with hypertension. Conclusions: Continuity of care was associated with a reduction in resource utilization and costs. As healthcare delivery systems are designed, care c ontinuity should be promoted.