Posted on October 30, 2007

Primary care turnover in private plans


Primary Care Provider Turnover and Quality in Managed Care Organizations

By Mary E. Plomondon, PhD, MSPH; David J. Magid, MD, MPH; John F. Steiner, MD, MPH; Samantha MaWhinney, ScD; Blair D. Gifford, PhD; Sarah C. Shih, MPH; Gary K. Grunwald, PhD; and John S. Rumsfeld, MD, PhD
The American Journal of Managed Care
August 2007

The median primary care provider turnover rate was 7.1% (range, 0%-53.3%). After adjustment for plan characteristics, health plans with higher primary care provider turnover rates had significantly lower measures of member satisfaction, including overall rating of healthcare.

Health plans with higher provider turnover rates also had lower rates of preventive care, including childhood immunization, well-child visits, cholesterol screening after cardiac event, and cervical cancer screening.

The cost of physician turnover is extremely high, estimated at 3.4% to 5.8% of a health plan’s annual operating budget.


By Don McCanne, MD

One of the most important goals of health care reform is to provide everyone with access to a primary care medical home. Not only would that enhance the quality and cost effectiveness of health care, but it would also provide each person with a long term relationship with a trusted health care professional.

The accelerating deterioration that is taking place in our primary care infrastructure threatens that goal. And private health plans are compounding that problem.

It is rare for an individual to be covered indefinitely by the same health plan. Employers often change their plans in an effort to slow the rate of premium increases. Individual employees frequently change their health plans when they have a change in employment. Young adults need new coverage when they are dropped from their parents’ plans. Since different plans use different lists of authorized providers, an individual may lose coverage of his or her primary care professional.

This study demonstrates that even maintaining the same health care coverage is not enough. A patient can lose his or her medical home merely because the insurer has a higher than average turnover in contracts with primary care professionals.

Clearly, placing a superfluous, intrusive private insurer between the patient and the primary care provider can be disruptive to the long-term coordinated care that a medical home should bring. Further, physician turnover is expensive, adding yet more waste to the administrative excesses that private insurers bring us.

Why should we want to have a choice of health plans when that will not assure us a stable choice of our physicians? Wouldn’t it be much better to switch to single payer national health insurance? Then we could always have choice of our own medical home and stay there for as long as we desire.