'Talk to your doctor': How primary care lowers costs, improves outcomes

Studies show that having a primary care provider (PCP) leads to better health outcomes and lower overall costs. Yet, despite the clear benefits, 100 million Americans lack an established PCP and only 53% of Premera Blue Cross members have one.

Why it matters 

Primary care isn’t just the front door to the healthcare system, but also the foundation of better outcomes, lower costs, and stronger relationships.

“At Premera, we’ve seen firsthand that members with an established primary care provider experience improved preventive care, fewer emergency visits, and greater satisfaction with their health plan,” said Romilla Batra, chief medical officer, Clinical Strategy & Solutions. “When patients have a doctor who knows them, they don’t just get care—they get better.”

Challenges to overcome 

Despite the clear benefits of primary care, there are also significant hurdles:

• Barriers to access: Nationally, average wait time for a PCP appointment is 31 days. In the greater Seattle area, the average wait time is 51 days.¹

• Overuse and high cost of emergency departments (ED): In 2021, there were 107+ million ED visits in the United States with aggregate costs amounting to $80+ billion dollars and private insurance as the expected payer was almost 35%.²

Centering primary care 

Premera is tackling these challenges with a multi-year strategy that centers primary care in our benefit designs, partnerships, and member experience initiatives.

“The best healthcare journeys begin with strong primary care,” said Nathan Johnson, vice president, Market/Product Solutions. “Our investment in Kinwell reflects our commitment to making advanced primary care more accessible for our members across Washington state. Through this exclusive collaboration, we’re elevating the role of primary care in everything we do—from how we design benefits to how we engage with our customers.”

Kinwell 

Kinwell offers an advanced primary care model, addressing physical, mental, and preventive health needs in one place. Kinwell makes it easier for patients to get the care they need without unnecessary referrals or long wait times. It enhances the patient experience, creates access, improves health outcomes, and lowers costs.

• 7-10%: Estimated better-than-market total cost of care for attributed members

• $0: Kinwell Connect members cost share for office visits³

• 88: Kinwell’s Net Promoter Score, almost double the industry average

Here’s what else we’re doing

In addition to Kinwell, here’s how we’re making “talk to your doctor” a tangible, affordable action for our members—and driving down costs in the process:

• Smarter plan designs

• Small group plans now offer designated PCP copays as low as $5, compared to $15+ for non-designated PCP visits.⁴ 

• Premera Blue Cross HMO positions the PCP as the central guide for care coordination.

• Premera Pathfinder expansion: PPO and EPO plan designs are available for all segments, including Preferred Choice, offering additional savings through Kinwell and designated PCPs.⁵

• PCP automatic designation

• For Pathfinder and small group plans in Washington, new members are automatically designated a PCP to encourage engagement and continuity of care.^4,5

• Preventive Care Push

• Campaigns for cervical and colorectal cancer screenings emphasize that care starts with your PCP.

Contact your Premera account representative to learn more.

1. https://www.amnhealthcare.com/siteassets/amn-insights/physician/ps-2025-physician-appt-wait-times—wp-v6.pdf
2. https://hcup-us.ahrq.gov/reports/statbriefs/sb311-ED-visit-costs-2021.pdf
3. Kinwell Connect is included with OptiFlex (51+) groups. Self-funded groups can opt-in.
4. Small group health plans with primary care provider designation are limited to the Choice and Balance PPO plans. High deductible health plans are not included.
5. Premera Pathfinder PPO plans are limited to the Preferred Choice health plans only.