How to Excel at Access — and Why It Matters


Patients do better and cost less when they have ready access to primary care, but could your practice be thinking about access all wrong?

Fam Pract Manag. 2018 Sep-Oct;25(5):27-33.

Author disclosure: no relevant financial affiliations disclosed.

Health care spending in the United States totaled $3.3 trillion in 2016, more than double the amount spent in 2000.1 Twenty percent of the cost went toward physician services,1 with primary care accounting for approximately 7 percent.2

These rising costs have real consequences for patients. A Kaiser Family Foundation survey found that, because of cost, 67 percent of the uninsured and 21 percent of the insured had forgone needed medical care.3 To address costs, payers are increasingly adopting reimbursement models that reward or penalize physicians based on their ability to keep costs down.

Now here's the good news: When it comes to rising health care costs, we in primary care are not the main problem, but we are a key part of the solution. This article will explain how improving access to primary care can reduce costs and the steps practices should begin taking now.


  • As a primary care physician, do not underestimate the power that access to your care has on reducing costs and improving health.

  • Commit to approaching access systematically, and review utilization data to identify key opportunities for improvement.

  • Not every patient request or problem needs the same time, method, person, or expertise from your practice. Begin to build your menu of access options.

  • Consider the modes of incoming access requests, the types of issues presenting, the team members available to meet the requests, and your scheduling methodology.


Research has shown that one of the most effective ways to address the cost problem in health care is to improve patients' access to primary care. The classic approach is to increase the supply of primary care physicians in a population or increase the ratio of primary care to specialty care. A 2004 study found that “Increasing the number of general practitioners in a state by 1 per 10,000 population (while decreasing the number of specialists to hold constant the total number of physicians) is associated with a rise in that state's quality rank of more than 10 places as well as a reduction in overall spending of $684 per beneficiary.”4

In other words, both quality and cost of care improve when patients have better access to a primary care physician. Having this trusting, continuous relationship increases the likelihood that patients will get the right care at the right time, potentially avoiding costly urgent and emergent care as well as hospitalizations.

Multiple other studies have also found that increasing access to primary care leads to positive results:5,6,7,8

  • Increased length of life, with fewer deaths due to heart and lung disease,

  • Better preventive care,

  • Reduced health disparities,

  • Less emergency department (ED) and hospital use,

  • Fewer


Dr. Mills is medical director of Ascension Medical Group – St. John Clinic in Tulsa, Okla., where he leads the clinic's transformation efforts around growth, access, and quality improvement. He has led participation in the multi-payer Comprehensive Primary Care (CPC) initiative and Comprehensive Primary Care Plus (CPC+), as well as guided a multi-site transformation to achieve the National Committee for Quality Assurance (NCQA) Level 3 Patient-Centered Medical Home (PCMH) designation.

Author disclosure: no relevant financial affiliations disclosed.


show all references

1. Rabah K, Cox C. How has U.S. spending on healthcare changed over time? Kaiser Family Foundation. December 20, 2017. Accessed August 16, 2018....

2. Goroll AH, Berenson RA, Schoenbaum SC, Gardner LB. Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care. J Gen Intern Med. 2007;22(3):410–415.

3. Kaiser Family Foundation. Kaiser Health Tracking Poll. August 2011. Accessed August 16, 2018.

4. Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries' quality of care. Health Aff (Millwood). 2004;23(suppl W4):184–197.

5. Greenfield S, Nelson EC, Zubkoff M, et al. Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992;267(12):1624–1630.

6. Forrest CB, Starfield B. The effect of first-contact care with primary care clinicians on ambulatory health care expenditures. J Fam Pract. 1996;43(1):40–48.

7. Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Serv Res. 2003;38(3):831–865.

8. Starfield B, Shi L, Grover A, Macinko J. The effects of specialist supply on populations' health: assessing the evidence. Health Aff (Millwood). 2005;24(suppl W5):97–107.

9. Yarnall KS, Østbye T, Krause KM, Pollak KI, Gradison M, Michener JL. Family physicians as team leaders: “time” to share the care. Prev Chronic Dis. 2009;6(2):A59.


Copyright © 2018 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz


May-Jun 2019

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now