A new study by Fair Health found that of Connecticut patients who had a medical visit from 2016 through 2022, one third (33.1%) had no claim for a primary care visit. Connecticut was 11th highest among states in patients missing primary care visits. At half of Connecticut’s rate, Massachusetts was the best in the country with only 16% of patients not getting primary care.
Primary care is important to preventing health problems and managing chronic conditions. It should be a patient’s medical home — coordinating their care with a person-centered team of professionals working to improve patient and population health. Areas of the country with fewer primary care providers experience worse access and worse health outcomes.
However, a primary care provider (PCP) shortage is not Connecticut’s problem. Connecticut’s ratio of population to PCPs is very close to the national average and far better than states with better rates of primary care visits.
Primary care providers include a range of providers; patients may see more than one type of PCP. Physician PCPs include internal medicine, family practice, obstetrics/gynecology, and pediatricians. Nonphysician PCPs include nurse practitioners and physician assistants.
According to Fair Health’s report, allowed amounts paid for the same primary care visits are about 18% lower for nurse practitioners than for physicians, with physician assistant reimbursement in the middle.
Similar to the average among states, a little over half (54.4%) of Connecticut PCPs are physicians.
Of those receiving primary care, most patients in Connecticut (85.3%) and the US see a physician PCP for care.
Far fewer patients are seen by a nurse practitioner for primary care. Just one in ten (10.2%) of Connecticut patients saw a nurse practitioner for primary care from 2016 through 2022. Care from nurse practitioners is usually more common in states, like Connecticut, that allow full practice, suggesting that Connecticut could expand capacity by increasing utilization of nonphysician PCPs.
Connecticut differed significantly in the percent of patients who saw a family medicine physician – second lowest in the US, just behind the District of Columbia. Family practice physicians typically care for all members of a family, adults and children, and are more common in rural areas.
Fair Health’s report also found low rates of access to primary care for patients with behavioral health primary diagnoses. In 2022, only 42.1% and 34.5% of US patients with a primary mental health or substance use diagnosis, respectively, were also seen by a primary care provider. Both these rates are well below the 71% average for all Americans. From 2016 to 2022, rates of primary care visits were up slightly for patients with mental health diagnoses, but down slightly for those with substance use disorder. Given the rise in both mental health and substance use problems due to COVID, these rates are concerning. State data on behavioral health patients and primary care use was not available.
State data on behavioral health patients and primary care use were not available.
FAIR Health is a national, independent nonprofit dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health possesses the nation’s largest collection of private healthcare claims data
Suggested citation for report:
FAIR Health, A Window into Primary Care: An Analysis of Private Healthcare Claims, A FAIR Health White Paper, March 15, 2023, https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/A%20Window%20into%20Primary%20Care%20-%20A%20FAIR%20Health%20White%20Paper.pdf.