Arindam Debbarma

Key Findings Many primary care clinics (PCCs) participating in the Minnesota State Employee Group Insurance Program (SEGIP) are willing to lower their prices to attain better tier placement, although they face obstacles to lowering total costs of care (which include specialists, hospitals, and pharmaceuticals).

Get full access to this article View all access and purchase options for this article. References Bardach N., Harder V., McCulloch C., Shaw J., Hart V., Cabana M. (2022). Follow-up after asthma emergency department visits and its relationship with subsequent asthma-related utilization. Academic Pediatrics, 22, S125–S132. Bazemore A., Merenstein Z., Handler L., Saultz J. W. (2023). The impact of interpersonal continuity of primary care on health care costs and use: A critical review.

Primary care clinics are a frequent focus of policy initiatives to improve the value of health care; yet, it is unclear whether they have the ability or incentive to take on the additional tasks that these initiatives ask of them. This paper reports on a qualitative study assessing barriers that clinic leaders face to reducing cost within a tiered cost-sharing commercial health insurance benefit design that gives both consumers and clinics a strong incentive to reduce cost.