The Choice is Yours and a Call to Action - Fixing The Primary Care Crisis
Everyone deserves comprehensive primary care provided by a PCP who can spend the time needed to listen and think. This means primary care physicians need to care for fewer patients and yet still to be able to earn a decent living. This will mean spending more money per patient for comprehensive primary care but in return it will drive down total healthcare costs.
The transformation needed will require the concerted efforts of patients and doctors. This may surprise you but change will only happen when patients become outspoken advocates. Solutions will not emanate from centralized planners mandating reforms.
Most of the innovation, as shown throughout this book, has come from individual primary care physicians who have decided to work directly with patients. Freed of the rules, they can innovate with direct pay/retainer/membership/concierge and other models. They can follow the precepts of the patient-centered medical home without concern about the associated rules, regulations and documentation. Some are beginning to address population health.
Direct patient care is but one of many options that can work. Among other innovative approaches to assuring a reasonable PCP to patient ratio: capitation in which the PCP receives either a large enough per member per month fee or is salaried so that the total number of patients is lessened from the current usual number (the example given was Erickson Living); insurers changing the fee-for-service reimbursement methodology to assure better care of chronic illnesses and enhanced preventive care (as with CareFirst); employers establishing their own primary care operations with an appropriate employee to doctor ratio (as with QuadMed and WeCare) or paying for primary care directly or indirectly via an HSA (as with Serigraph); insurers deciding to pay a monthly fee for primary care (as with Nevada Health Coop in association with Turntable Health), and placing extensive resources into primary care for the benefit of those with multiple chronic illnesses and socioeconomic deprivation (as is the case with AbsoluteCARE and Iora Health).
In the last pages of the book I provide explicit recommendations as to what each stakeholder-patients, primary care physicians, employers, insurers (and by extension, government), and leaders of academic medical centers-can do to convert to a true comprehensive primary healthcare system with this goal before them: Create a primary care system that offers high quality comprehensive care to a satisfied patient by an enthusiastic and energized physician (or other provider) at a reasonable cost that lowers the total cost of care.