Targeted investments in primary care and preventive care can significantly improve health outcomes, reduce avoidable high-cost care and strengthen Indiana's long-term economic competitiveness, according to a new report from the Center for Health Policy at the Indiana University Richard M. Fairbanks School of Public Health at IU Indianapolis.
The report, "Increasing Primary Care and Preventive Care Utilization in Indiana: A State-Level Approach," was commissioned by the Indiana Business Health Collaborative. It provides Indiana-specific analysis and recommendations for policymakers, employers, insurers and health system leaders as the state pursues strategies to lower health care costs and improve population health.
Aparna Soni is an associate professor of health policy and management at the Fairbanks School. Photo courtesy of the Fairbanks School
Drawing on national peer-reviewed research and comparative state-level data, the report examines trends in Indiana's primary-care workforce, health spending and use of recommended preventive services relative to neighboring and comparable states. It also assesses the effectiveness of a wide range of policy, payer, employer and provider strategies to increase access to and use of primary care and preventive services.
Key findings from the report show that:
- Health care quality and outcomes improve when patients use primary care more frequently.
- Avoidable emergency department visits decline with increased primary care use.
- Total health care spending trends improve within 12 to 36 months due to reduced acute and specialty care.
- Patient experience improves, particularly for rural, low-income and high-need populations, when care is team-based and well-coordinated.
- The strongest results occur when financing is paired with benefit design (such as zero out-of-pocket costs for high-value preventive and primary services), data sharing and patient engagement strategies.
Luke Messer is the chief executive of the Indiana Business Health Collaborative.
The report identified several strategies that are most likely to expand access to and use of primary and preventive care in Indiana. These include:
- Expanding health insurance.
- Increasing support for federally qualified health centers and community clinics.
- Broadening scope-of-practice for advanced practice providers.
- Investing in graduate medical education in high-need areas.
- Providing paid sick leave.
- Reducing patient cost-sharing.
- Adopting value-based or hybrid payment models that better support primary care teams.
- Increasing reimbursement rates for primary care providers.
- Creating collaborative and team-based care models.
- Reminding and nudging patients.
The report also cautioned that some common approaches, such as workplace wellness programs, high-deductible health plans and certain forms of virtual primary care, do not increase primary and preventive care use and may have unintended negative effects in some cases.
"Indiana doesn't need to spend more on health care overall to see better results," Soni said. "The evidence shows that spending smarter, by investing in primary care and prevention, can deliver meaningful benefits for patients, employers and taxpayers alike."
Nir Menachemi, dean and professor at the Fairbanks School, is a co-author of the report. Andrea Renzi-Burns, and Lindsey Sanner, are members of the project team.
