Recon Strategy: More Frequent Visits to Primary Care Can Save Net $30-40 PMPM for Top 20% Highest Risk Commercial Members

Cambridge, MA – September 29, 2025 — A new study published in The American Journal of Managed Care finds that more routine primary care visits for higher-risk commercially insured patients are linked to lower overall healthcare costs.

A research team from Recon Strategy analyzing nationally representative data from the AHRQ Medical Expenditure Panel Survey showed that the top quintile of patients with greatest clinical risk could benefit from “high-touch” primary care. For those with double the average clinical risk score (commonly seen with diabetes, inflammatory disease, and behavioral conditions), two to four primary care visits per year were associated with savings of $34 PMPM. Because it is based on nationally representative data, the impact is not the result of a particular clinical approach or practice.

“We often forget that much of the commercial population is afflicted with the same polychronic conditions and comparable clinical risk as Medicare patients,” said Tory Wolff, Managing Partner at Recon Strategy and co-author. “This research demonstrates that when primary care teams focus their attention on the right patients, the payoff can be material at both the patient and population level.”

Because higher-risk members contribute disproportionately to overall spending, these savings could significantly reduce net population costs if optimally stratified. The findings suggest that advanced primary care models—already successful in Medicare Advantage—can be adapted to commercial populations if health plans and providers align incentives and direct more clinical attention to the riskiest patients.

By contrast, additional visits for lower-risk patients tended to raise costs, highlighting the importance of targeting care precisely. “Plans and providers need to be precise,” added co-author Jacob Wiesenthal. “Extra visits for the wrong patients can backfire and actually be associated with higher overall costs. But with the right targeting and the right cadence, more primary care can bend the cost curve.”

Though previously studied in Medicare eligibles, the study is the first to confirm this effect among commercially insured patients. It helps quantify a meaningful cost-saving opportunity for employers and inform the optimal population health management strategy for insurers, providers, and policymakers to expand high-touch, risk-stratified primary care models beyond Medicare.

You can read the full study here.

About Recon Strategy

Recon Strategy is a consulting firm focused exclusively on healthcare strategy. Founded in 2010, the firm helps payers, providers, biopharma, medtech, and digital health innovators tackle their most important strategic challenges. The firm combines deep partner engagement, industry expertise and analytical capabilities with a highly collaborative consulting model to deliver practical, high value insights to its clients.