Authors: Marc Matthews, Allison Matthews, Rose Anderson, Jo Bernau and Lorna Ross.
Primary care is at a critical crossroads. Our current delivery systems are unsustainable and lack the resiliency to survive in new environments where total cost of care, patient experience, and patient centered outcomes are the primary determinants of success. In order for primary care to remain relevant and viable, new solutions must be created that are practical and transformative, attract and retain new patients and provide high value, high satisfaction services that meet their consumer needs. Primary care has to especially think about how we can demonstrate our value in coordinating care, especially in managing populations of patients and subpopulations with multiple chronic conditions. Our cost of care must come down and our quality must remain high in order for us to be able to deliver affordable care in future reimbursement realities. However, we cannot solve this problem with the same thinking that got us into this predicament in the first place.
Primary care providers have traditionally seen their value in maintaining a longitudinal provider-patient relationship. Research and experience have demonstrated that, when fully realized, this relationship decreases total healthcare expenditures with improved quality outcomes. However, regulatory and payment changes that started about a decade ago are now gaining momentum and will have significant impact on the ability of primary care providers to maintain this same depth of relationships with all of their patients. More people will now have access to health insurance and because of this there will be increasing demand on a shrinking pool of primary care providers. One option would be to simply continue as we always have and try to maintain relationships with more and more patients. Widely cited research shows that to accomplish all the necessary preventive services for the current average panel size would take 27 hours a day. And yet, because the work necessary to keep people healthy isn’t valued enough to be reimbursed properly, primary care practices have become places where acute illnesses are treated while long term health goals are pushed aside to maintain higher and higher volumes and productivity. Another option would be to look around us at the dedicated nursing and support staff in our clinics and tap into their vastly underutilized skills and knowledge to distribute the work of maintaining relationships and caring for more and more patients.