In coming years, the ability to craft a strong primary care model will become a key determinant of a hospital’s success. Winning organizations will be those who understand that the pluralistic primary care model will incorporate more than physicians and will focus on new models and ways of creating comprehensive care continuums for patients and their communities.
The shift away from primary care being defined as a family practice or internal medicine physicians will continue to accelerate. The growth of nonphysician providers has already outpaced primary care physician growth and will continue to play a larger and larger role in the provision of care1. New models driven by the big retailers such as MinuteClinic and other nontraditional providers, as well as clinical nurse specialists focused on chronic care management, will continue to shape how care is delivered.
Historically, the primary care physician was the center of the relationship as the expert in charge of organizing and deploying assets and capabilities to deliver care. Future trends suggest that the patient will move to the center. Primary care will then be defined by the array of services the patient can access.
But given the complexity of the care process and the limitations of knowledge transfer to patients, the coordination and distribution role will still be a necessary and integral part of comprehensive care.
However, how this vital role is filled will likely shift. Independent physicians have neither the incentive nor the necessary skills and infrastructure to fill the role entirely.
First, there is little incentive for primary care physicians to take on this key role within the professional fee and work-RVU structure. Some, such as members of the Medical Home and Accountable Care Organizations, have proposed alternate models to compensate physicians (particularly primary care physicians) for a possible new role. But the broader strategic reality is that primary care physicians are unlikely to be the best providers of this element of care.
For decades, primary care physicians have been trained to diagnose, treat and manage disease. To expect them to take on the dramatically different role of coordinator for all components from prevention to chronic care management—using new, nonphysician-centric models, no less—is unrealistic. Instead, physicians are best suited to be efficient components of the delivery process.
By contrast, hospitals have strong experience coordinating and organizing complex, multi-individual processes. Additionally, they have strong connections to local communities, making them the logical organization to organize primary care.
However, hospitals are not the only organizations positioned to do so. Payors, physician groups, retailers and large employers all have unique capabilities that may give them success in organizing primary care, as we have seen throughout the United States.
New Approaches to Organizing Primary Care
The coordination and delivery of primary care continues to evolve away from the current physician-centric model. Here are some examples.
Denver-based Integrated Physician Network (IPN) coordinates 140+ physicians with common electronic records and consistent indicators to demonstrate differentiated quality and better value for patients and payors. IPN affects the prevention, diagnosis, treatment, support and connectivity portions of the continuum.
Arizona Community Physicians (ACP), based in Tucson, coordinates a confederation of 105+ physicians and 40 mid-level providers with common emergency medical records, quality and financial structures to improve care for the community and patients. ACP affects the prevention, diagnosis, treatment, support and connectivity portions of the continuum.
Integrated, vertical systems, such as HealthPartners and Kaiser, can control all components of the care continuum from prevention through acute care services, as well as coordinate community support and provision of home health services.
MinuteClinic focuses on prevention, diagnosis and treatment services through mid-level providers. They do not have medical home or community support; yet through service and convenience, MinuteClinic now has more than 2,000 locations.
Colorado’s Summit County contracted directly with a physician group outside of the relationship with the local hospital for improved service and care for county employees. This model focuses on prevention, diagnosis, treatment and community support services.
1 The number of physician assistants in clinical practice has grown 70% over the past eight years, from 43,000 in 2001 to 74,000 in 2008; American Academy of Physician Assistants.
23 August 2010