Changes in Outpatient Visits in a Medicaid Population in the Face of Physician Shortages
Author(s)
Brenna Brady, PhD, Helen Varker, BS, Liisa Palmer, PhD;
Merative, Ann Arbor, MI, USA
Merative, Ann Arbor, MI, USA
Presentation Documents
OBJECTIVES: The US is facing physician shortages which threaten healthcare access. Forecasts by the American Association of Medical Colleges indicate the US could be lacking 48,000 primary care physicians (PCPs) and 77,100 non-PCPs by 2034. This analysis investigated trends in outpatient (OP) care utilization among patients covered by Medicaid from 2016 to 2022.
METHODS: Calendar year cohorts with continuous eligibility were identified in the MerativeTM MarketScan® Multi-state Medicaid database from 2016 to 2022. OP healthcare utilization was evaluated in each year by visit type (PCP, specialist, behavioral health, urgent care [UC], and other professional). Utilization of office-based versus telehealth services, as well as PCP visits with a medical doctor (MD) versus a physician assistant (PA) or nurse practitioner (NP), were also assessed.
RESULTS: Annual cohorts included approximately 3 million adults and 4-5 million pediatrics. Although utilization varied year-to-year, adults generally demonstrated an increase in PCP visits with an 11.6% increase from 2016 to 2022; conversely, pediatrics saw an 8.2% decrease from 2017-2022. UC visits increased in both adults (5.6%) and pediatrics (4.8%) from 2016-2022. A shift to PA/NP PCP visits was also observed over the study period (6.7%-20.5% in adults and 10.3%-15.3% in pediatrics). Telehealth use peaked in 2020 with 25.0% of adults and 17.0% of pediatrics with ≥1 telehealth visit compared to <3.0% in 2016. The greatest telehealth increases were observed for behavioral health (52.2% in adults, 26.5% in pediatrics), however notable increases (>10%) were also observed for PCP and specialist visits.
CONCLUSIONS: Study findings indicate alterations in OP care over time with increased reliance on urgent care, telehealth, and non-MD providers. For adults, these changes appear to be culminating in increased healthcare access, unfortunately the opposite trend is observed in pediatrics. The increased reliance on UC visits may also be concerning as these interactions are less likely to provide preventative care services.
METHODS: Calendar year cohorts with continuous eligibility were identified in the MerativeTM MarketScan® Multi-state Medicaid database from 2016 to 2022. OP healthcare utilization was evaluated in each year by visit type (PCP, specialist, behavioral health, urgent care [UC], and other professional). Utilization of office-based versus telehealth services, as well as PCP visits with a medical doctor (MD) versus a physician assistant (PA) or nurse practitioner (NP), were also assessed.
RESULTS: Annual cohorts included approximately 3 million adults and 4-5 million pediatrics. Although utilization varied year-to-year, adults generally demonstrated an increase in PCP visits with an 11.6% increase from 2016 to 2022; conversely, pediatrics saw an 8.2% decrease from 2017-2022. UC visits increased in both adults (5.6%) and pediatrics (4.8%) from 2016-2022. A shift to PA/NP PCP visits was also observed over the study period (6.7%-20.5% in adults and 10.3%-15.3% in pediatrics). Telehealth use peaked in 2020 with 25.0% of adults and 17.0% of pediatrics with ≥1 telehealth visit compared to <3.0% in 2016. The greatest telehealth increases were observed for behavioral health (52.2% in adults, 26.5% in pediatrics), however notable increases (>10%) were also observed for PCP and specialist visits.
CONCLUSIONS: Study findings indicate alterations in OP care over time with increased reliance on urgent care, telehealth, and non-MD providers. For adults, these changes appear to be culminating in increased healthcare access, unfortunately the opposite trend is observed in pediatrics. The increased reliance on UC visits may also be concerning as these interactions are less likely to provide preventative care services.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EPH44
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas