• David P Glass, Michael H Kanter, Steven J Jacobsen, and Paul M Minardi.
• Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
• J Eval Clin Pract. 2017 Dec 1; 23 (6): 1451-1458.

ObjectivesTo measure the size and timing of changes in utilization and costs for employees and dependents who had major access barriers to primary care removed, across an 8-year period (2007 to 2014).Study Design And MethodsRetrospective observational study examining patterns of utilization and costs before and after the implementation of a worksite medical office in 2010. The worksite office offered convenient primary care services with no travel from work, essentially guaranteed same day access, and no co-pay. Trends in visit rates and costs were compared for an intervention fixed cohort group (employees and dependents) at the employer (n = 1211) with a control fixed cohort group (n = 542 162) for 6 types of visits (primary, urgent, emergency, inpatient, specialty, and other outpatient). Difference-in-differences methods assessed the significance of between-group changes in utilization and costs.ResultsThe worksite medical office intervention group had an increase in primary care visits relative to the control group (+43% vs +4%, P < 0.001). This was accompanied by a reduction in urgent care visits by the intervention group compared with the control group (-43% vs -5%, P < 0.001). There were no differences in the other types of visits, and the total visit costs for the intervention group increased 5.7% versus 2.7% for the control group (P = 0.008). A sub-group analysis of the intervention group (comparing dependents to employees) found that that the dependents achieved a reduction in costs of 2.7% (P < 0.001) across the study period.ConclusionsThe potential for long-term reduction in utilization and costs with better access to primary care is significant, but not easily nor automatically achieved.© 2017 The Authors Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.

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