Assigned But Not Anchored: A Study of Primary Care Provider Utilization Among Covered California Enrollees.

backgroundHigh-quality primary care is paramount for health equity and cost containment, yet many individuals lack access to a usual source of care. Since 2017, Covered California, the ACA Marketplace, has required all health plans to match enrollees with a PCP to serve as a first point of contact to promote high-value primary care.

objectiveTo understand primary care and overall healthcare utilization patterns for enrollees on ACA marketplace plans.

designThis study analyzed primary care utilization patterns across 1.1 million Covered California enrollees in 2022 under this policy and examined differences in usage of assigned and non-assigned PCPs across product types.

participantsIn total, 1,112,292 Covered California enrollees aged 18 years or older in 2022. MAIN MEASURES: Our main measures included utilization rates for assigned primary care providers (PCPs), utilization rates of other PCPs, utilization of all non-primary care services, and rates of non-utilization of healthcare services. KEY

resultsResults indicated that while enrollees in PPO or EPO plans had higher overall rates of PCP utilization, differences in PCP usage disappeared after correcting for demographic and clinical differences between enrollees in HMO and PPO/EPO plans. However, visits to non-assigned PCPs are common in all plan types. And, 43% of adult enrollees with 12-months continuous enrollment did not have any primary care visits.

conclusionsWe recommend that policy makers promote consistent utilization of any PCP regardless of PCP assignment, as we found that many people use other-than-assigned PCPs even when current policies intend to proactively steer them towards one main point of contact.