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Does Primary Care Need To Be Retooled?

Joe Cantlupe, for HealthLeaders Media, March 14, 2013

Indeed, there is much discussion about population health, medical homes and Accountable Care Organizations with primary care physicians playing important roles. That's nice, Porter and Lee say, but those models still fall short of the multidisciplinary, collaborative teams needed to augment primary care.

"We're saying 'let's take it one step further,'" Porter says. "What are the primary care needs of different individuals?"

Porter and Lee acknowledge that their model certainly poses difficulties for small practices, but they insist small physician groups should not be excluded.

"There are a whole bunch of forces challenging the one and two doctor practice going forward," Lee admits. "I don't think anyone will look back and say this paper by Mike Porter and Tom Lee put them over the edge. There are ways to get physicians spread out, even in rural settings, to work together. They have to be ready to want to work together and collaborate with colleagues to improve the value of care for patients over time."

Change must be in the offing for primary care, Lee insists. "I don't think anyone feels like things are stable and that all (physicians) need to do is just show up for work and work as they currently are working and be OK," Lee says. "We want to provide this strategic framework to make something happen, as opposed to fretting about it."


Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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1 comments on "Does Primary Care Need To Be Retooled?"


George Anstadt MD FACOEM FACPM (3/14/2013 at 9:37 PM)
The Lee /Potter proposal: subjugate primary care physicians, and the patient's interests that the primary guards, using "market share" mechanism coupled with a "Strategic Frameworks" panacea; specialists and the system know best, or will know best as soon as Lee can assign someone the task of value guru. Further fractionate and specialize. The system with the most specialist wins. The patient centered notion is wrongheaded. In fact, as you look for value in the real world, the nations with the highest ratios of primary to specialty care are the best. For example, it is widely recognized that the US does 10x greater spine surgery than other nations, without any observed benefit in terms of spine health, but at far greater cost. No health status benefit / very high spine surgeon incomes + hospital charges + device prices = poor value. Lee contends that no one in his system is focused on health care value; yet, the primary is trained to provide value, which is best achieved by preventing disease in the first place, and also by finding simple solutions rather than tertiary care for problems. The US healthcare system impedes good primary care, especially prevention, with both financial disincentives and procedural barriers; never-the-less, if Dr. Lee were to examine the outcomes of his primary care doctors at the individual physician level, he would find a dedicated and caring minority who still do the right things, despite the difficulties, and as a result are getting much better health status outcomes, e.g. fewer MI, less new onset diabetes, etc., which save our healthcare system huge amounts of money. These are the overlooked folks in his system who are trained to provide value, and who ARE providing value. He should identify them, celebrate the increased health and decreased cost (value) that they are providing to our healthcare system, reward them financially, and learn from them. Their best practices should be facilitated with administrative and technology investments, and then shared them with the other primary care providers, which will not be a hard sell. Most of these primary care docs are longing to do these right things, but need encouragement, tools, time and financial incentives. Trouble is, insurance doesn't reward value, only encounters and procedures. So, Lee will have to figure out how to get paid for value, or just keep hiring more guys who do high revenue procedures, and push his primary care docs to encounter more people per hour. Our medical students are watching. Do we want more spine specialists and even fewer primary care docs?