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CME Credits

Primary Care Innovations Providers Should Know (And Prepare For)

Primary care is seeing more than its share of changes, even as the compassionate professionals within it attempt to overcome the healthcare industry’s toughest challenges.

Many of these primary care innovations are well received and the future of the specialty looks bright. Each primary care innovation will impact economic, care and education models in ways that will require PCPs to adapt. Continuing education programs such as CME can help practitioners stay in front of these changes and integrate new techniques into their practice.

Value Based Care

Healthcare stakeholders are in agreement that the fee-for-service model is not appropriate for all types and modes of care. Value based care can provide a viable alternative, even if it isn’t implemented for every health population or condition. Value based care works by incentivizing more effective care rather than a higher volume of it. Insurer payouts to practitioners are determined by the health status of patients, measuring whether care improved patient conditions. Not only does this promote practitioners’ accountability but has the potential to reward great PCPs whose positive treatment data attracts patients interested in the most effective available care. A larger number of patients at higher insurance reimbursement rates under value based care schemes could mean financial relief for strained PCPs.

Integrated Care Management

During the 1990s and early 2000s, the US insurance system made the primary care providers the focal point of the healthcare system. The idea was to have primary care act as a filter, catching less serious medical conditions before they advanced and sending more severe cases on to a relevant specialist. But patients and PCPs grew tired of a model that shrunk their scope of practice and incentivized patients to wait before seeking needed care to avoid high healthcare costs. This dynamic is partially responsible for the reduced patient volumes impacting the financial well being of primary care practices over the last 15 years.

Integrated care has the potential to reverse this trend while providing higher-quality services to patients. In the integrated care model, PCPs are still a focal point but are also empowered to take on a wider variety of cases. The reduced emphasis on other specialists means cultivating long term relationships with patients, which can include more preventive healthcare as well as intensive, comprehensive care for sicker patients.

Integrated care could improve the quality of care while reducing costs in three ways:

  1. Limited healthcare waste by connecting practitioners, records and care facilities.
  2. Less reliance on patient volume-focused, fee-for-service care.
  3. Comprehensive prevention and early-stage care freeing more patients from the need for more advanced care.

Digital Measurement and Patient Outcomes

The long term relationships PCPs are able to foster has the added benefit of observing a patient’s condition over time. With the right methods to collect, analyze and interpret short term and longitudinal patient data from primary care practices, primary care specialists and healthcare stakeholders can more accurately measure their impact on patients.

The system can look to high performing PCPs for tested and proven ideas for benefiting more patients. Alternatively, lower performing PCPs will be able to receive targeted support from healthcare facilities and policymakers interested in the impact of primary care on their constituencies. PCPs would collect qualitative and quantitative patient data at several points through the care delivery process, including patient outcomes. Work must still be done to agree upon and standardize the variables that would serve as quality care metrics. For chronically ill patients, hospital admissions or readmissions are important metrics. For healthier patients, patient experience surveys and reduced healthcare utilization are promising.

Nontraditional Primary Care

Nontraditional primary care options include retail clinics, payer-led services and advanced primary care providers. These models are almost certainly going to disrupt the financial structure of traditional primary care fee-for-service models but they will also have an impact on care quality.

Major advantages of these nontraditional players include scalability and population health targeting. Traditional primary care clinics, either practitioner owned or offered through a local or regional hospital system, are spread thin because they are required to treat a range of conditions, even when serving small populations. Retail care is expected to rely heavily on telehealth and remote patient monitoring, in addition to being geographically diffuse, allowing it to target health populations by health status, rather than location.

These trends will also influence traditional primary care models by providing a basis for innovation. PCPs in traditional environments are likely to see a proliferation of digital tools that will become less expensive as they are more widely adopted. Through these technologies, providers can offer more targeted and patient-centric care to compete with alternative models.

Direct Primary Care

Direct primary care (DPC) is a new payment model that is changing how patients receive primary care services. Practitioners who own DPC practices deliver comprehensive care for a flat membership fee billed monthly, quarterly or annually. This membership often covers unlimited patient visits and near continuous access to providers. The fee will cover a variety of services commonly considered to be part of comprehensive primary care services including consultations, case management and care coordination. DPC practices may even offer their own pharmaceutical, radiological and testing services, providing patients with a “one-stop-shop” for their primary care.

By eliminating third-party payers and fee-for-service models, DPC practitioners can provide a wide variety of benefits and services to patients. Patients enjoy more ready access to health services through DPC clinics while spending additional time with doctors when they are seen. Doctors find that reduced practice overhead, increased control and a smaller administrative footprint of DPC offsets any lost revenue resulting from the switch.