Cost savings from primary care clinic continuity among patients with chronic disease in Alberta, Canada: a retrospective population-level cross-sectional study

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BACKGROUND: Continuity of care with a primary care physician (PCP) is well known to improve patient health, result in less health service utilisation (HSU), and lower costs. Less is known about the impact of clinic continuity related to team-based care and shared practice models. Information on the cost impact of such models is needed to guide design and payment policies. AIM: To estimate savings in HSU costs for patients with chronic disease when they are moved from primary care clinics with low and moderate continuity levels to those with high levels. DESIGN AND SETTING: A 3-year retrospective population based cross-sectional study examined the HSU costs associated with three levels of primary care clinic continuity for approximately 70 000 matched patients from a cohort of 500 000 patients with chronic disease in Alberta, Canada. All fee-for-service PCPs were included. METHOD: Clinic continuity was calculated by adapting the Usual Provider of Care (UPC) Index. Costs were estimated using costing methodologies from the Canadian Institute of Health Information. RESULTS: The association between continuity and acute care costs suggests achieving high clinic continuity (UPC 80-100%) for all 195 000 patients in less than high clinic continuity care could theoretically yield upwards of £898 million over 3 years. Estimated per-patient gains were highest among the most medically complex patients. CONCLUSION: Cost savings were associated with clinic continuity among patients with common chronic diseases at all levels of complexity. Significant cost savings could be realised by focusing patient care on primary care clinics that favour high levels of continuity.