Primary Care Needs New Innovations to Meet Growing Demands

HealthLeaders Media Staff, May 27, 2009

The impact of a shrinking pool of primary care providers, combined with an increased demand for primary care services, has created a crisis of sorts in healthcare delivery. Keeping this in mind, now may be the time to consider newer approaches in care delivery in order—especially with healthcare reforms on the horizon—to improve quality and outcomes, according to a new report, Remaking Primary Care: From Crisis to Opportunity by the New England Healthcare Institute.

On the demand side, primary care is faced with a growing percentage of Americans who are living longer, often with one or more chronic diseases. "Most people assume that's just the wave of the Baby Boomers and that's not the case," said Wendy Everett, NEHI's president.

Currently, 87% of Americans aged 65-79 live with at least one chronic condition. Much of the care provided to this population has shifted from hospitals to ambulatory care settings, and this is expected to increase—stressing the primary care system.

It has been estimated that roughly 5% of that population accounts for 50% of Medicare costs. If universal coverage is approved, it will mean redefining the healthcare system and focusing on coordinating care for that group of patients, Everett said. "Primary care is the place to do it."

On the supply side, NEHI cited the lower pay of primary care physicians and dissatisfaction over high workloads, long hours, and a sense of being undervalued as pushing existing providers out of the profession while stopping new physicians from pursuing primary care. The proportion of primary care physicians has decreased from 50% of all physicians in 1950 to just over 30% in 2007.

"The biggest shift is going to be to get physicians to think about delivering primary care in a team model," Everett said.

This type of transformation would mean training physicians to work with teams of registered nurses, medical assistants, and other professionals to help deliver more seamless, effective care, according to the report.

Other innovations to consider are:

  • Patient-centered medical home to centralize care at a single clinical setting.
  • New sites of care that offer primary care services at retail clinics and worksites.
  • Health information technology, such as electronic medical records and computerized prescription ordering to free up physician time during visits and help in coordinating care.
  • Improved pay-for-performance to pay for outcomes will move the system away from paying for episodic care.
  • Shared medical appointments to help improve access to physicians.
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