Why Primary Care Should Pay Attention to Continuity of Care

June 29th, 2015 / By L. Gordon Moore, MD

Reducing healthcare costs through better care delivery begs the question: “Where do we start?” When the goal includes something to the effect of “the greatest possible improvement for a population,” it is good to reflect on the body of evidence pointing to high performing population health outcomes.

The work of Starfield and others is instructive: High performing health systems have high performing primary care as their foundation. High performing primary care has four cardinal features:¹

  • First point of access
  • Person-focused relationship over time
  • Coordination across the continuum of care
  • Provides comprehensive services

A recent piece on continuity of care in Medicare reiterates this case. Medicare beneficiaries with better continuity of care are less likely to undergo unnecessary procedures.²

This is consistent with another study looking at the relationship between continuity of care and hospitalization, ED use and complications in Medicare beneficiaries with chronic conditions. They found a 4-6% lower total cost of care with better continuity of care. (See Figure 1 below)³

Gordon continuity of care

Continuity of care is a proxy for Starfield’s “person-focused relationship over time.” We can measure this with claims data using the Bice-Boxerman index (the measure used in these studies).4

The choice of metrics matters because metrics drive work–but primary care is inundated with metrics. When considering the relative value of metrics, it would be reasonable to consider continuity of care as one that reflects a core attribute of high-performing primary care and is linked to important outcomes.

L. Gordon Moore, MD, is senior medical director for populations and payment solutions at 3M Health Information Systems.


¹Macinko, James, Barbara Starfield, and Leiyu Shi. “Quantifying the Health Benefits of Primary Care Physician Supply in the United States.” International Journal of Health Services: Planning, Administration, Evaluation 37, no. 1 (2007): 111–26.

²Romano MJ, Segal JB, and Pollack C. “The Association between Continuity of Care and the Overuse of Medical Procedures.” JAMA Internal Medicine, May 18, 2015. doi:10.1001/jamainternmed.2015.1340.

³Hussey PS, Schneider EC, Rudin RS, Fox D, Lai J, and Pollack C. “Continuity and the Costs of Care for Chronic Disease.” JAMA Internal Medicine 174, no. 5 (May 1, 2014): 742–48. doi:10.1001/jamainternmed.2014.245.

4Bice, T. W., and S. B. Boxerman. “A Quantitative Measure of Continuity of Care.” Medical Care 15, no. 4 (April 1977): 347–49.