Revitalizing and growing primary care

In my last blog I addressed the need to create a culture of health in communities across America as one of five key actions that will help achieve the Triple Aim of better health, better care and lower costs. Revitalizing and growing primary care is a second key action to achieving truly sustainable health care reform and helping reduce the medical cost trend.

Primary care physicians (PCPs) are often the first point of contact for patients to access the health care system. They significantly improve the way care is delivered through improved coordination with specialists and other providers. Strong primary care can improve health outcomes, reduce health disparities across a population and lower costs.

Strengthening Primary Care for Patients, published in April by the Alliance of Community Health Plans (ACHP), describes efforts undertaken by 17 of our member organizations to improve the U.S. health care system by transforming primary care. It focuses on key components of primary care redesign and the potential for improved patient care.

The role of primary care will be even more important as millions of new enrollees move into the health care marketplace beginning in 2014.

While the expansion of insurance coverage resulting from the Affordable Care Act (ACA) will continue to raise demand, we face a critical shortage of PCPs. Many of them are retiring, and fewer medical students are choosing careers in primary care, opting instead to become specialists.

A study published in the December 2012 Journal of the American Medical Association fuels concerns there will be a shortage of PCPs when patients need them most. Of nearly 17,000 third-year residents, only 21.5 percent said they are planning a career as an internal medicine physician.

The study’s author estimates, “In the next decade, we will be 50,000 PCPs short for the needs of the country” concluding, “Access to primary care is threatened by these numbers if we don’t do something about it.”

A second study, this one issued by the Health Association of New York State (HANYS), provides some similarly discouraging news. Doctor Shortage: Condition Critical found New York state faces a critical shortage of physicians, especially in rural areas, and the shortage is expected to get worse.

One-third of the shortage is in primary care, due largely to increased demand placed on PCPs compared to their specialist colleagues, and traditionally lower reimbursements.

Independent Health is working to address the physician shortage on two fronts – through a ground-breaking collaboration with a pioneering group of community physicians known as The Primary Connection (as featured in “Strengthening Primary Care for Patients”) – and by reaching out to colleges and universities with training and mentoring opportunities.

Using patient-centered medical home principles as its foundation, The Primary Connection seeks to radically redesign primary care and transform health care delivery in western New York.
Launched on July 1, 2012, it now involves 35 primary care practices and more than180 adult and pediatric primary care physicians. These practices are becoming model settings and expanding their capacity to treat more patients through the development of care teams.

The Primary Connection allows participating PCPs to be a vital part of improving our health care system while expanding their influence and providing more patient-centered care. These physicians have become more energized in terms of how they are approaching their ability to impact patients and the community.

Through this initiative we have already seen improved physician satisfaction and professional fulfillment as well as overall team vitality. The Primary Connection is also resulting in improved patient experience of care and decreased costs due to better coordination of care, the elimination of duplicate services and reducing unnecessary hospital readmissions.

Collaboration with local colleges and universities will hopefully encourage medical and nursing students to choose primary care as their specialty. This collaboration includes:

          -Several medical residents from the University at Buffalo School of Medicine are receiving their third-year primary care clinical training experience at physician practices that are part of The Primary Connection.

          -Two fourth-year medical students who have chosen primary care as their specialty are     serving as ambassadors for the field among their peers.

          -The Primary Connection hosted a luncheon for medical students to attend and meet a panel of its member physicians and will continue to offer these networking opportunities.

 In addition to partnering with physicians and colleges and universities, Independent Health is working closely with PCPs, specialists, hospitals and other providers to offer two new tailored-network products on July 1 that will improve the quality and integration of care.

Both innovative product designs – which capitalize on the strength and highly collaborative nature of our provider relationships – will result in better care, increased patient piece-of-mind, and lower health care expenses.

The goal is to make health care delivery more consumer-friendly and less confusing through a greater alignment of the health system – a third key action to be discussed in my next blog.

Michael Cropp, M.D.
President and CEO, Independent Health
2013-2014 Chair of ACHP Board of Directors