Effects of cost-containment strategies within managed care on continuity of the relationship between patients with depression and their primary care providers

BACKGROUND. Continuity of the relationship between patients and primary car e providers (PCPs) is an important component of care from the consumer pers pective that may be affected by variation in cost containment strategies wi thin managed care. OBJECTIVE. To evaluate the effects of cost containment strategies on the co ntinuity of the relationship between their patients with depression and the ir PCPs. DESIGN. Observational analysis of a 2-year panel of depressed patients who participated in a quality improvement intervention trial in 46 managed care practices. PARTICIPANTS. One thousand two hundred four patients with current depressio n who enrolled in a longitudinal study, completed the baseline survey, and were followed for 2 years. MAIN MEASURES. The dependent variable is probability of continuing the rela tionship between patients and their PCPs; explanatory variables include ind ividual patient mental health benefits and cost-sharing, individual provide r financial incentives, supply-side managed care policies, and patient rati ngs of the care received. RESULTS. The average duration of the patient-PCP relationship was significa ntly longer among depressed patients who initially had less generous benefi ts for specialty care (higher copays, P = 0.02 and fewer visits covered, P = 0.002) and for patients whose PCPs received a performance-based salary bo nus from a risk pool (P = 0.07). CONCLUSIONS. For depressed patients, cost containment strategies, such as l imits on specialty benefits and presence of clinician bonus payments typica lly used within managed care may increase, rather than decrease, PCP contin uity. Whether increased PCP continuity is a desirable outcome depends on wh ether health care systems can provide high quality primary care and this me rits further study.