Primary Care-Based Organizations That Are Improving Care - Fixing The Primary Care Crisis

Innovative, enthusiastic groups that are committed to reinvigorating primary care are already developing grass roots interest and advocacy, while others are establishing new models of care that include the various options I have advocated throughout this book. Primary Care Progress, founded by young primary care providers and students contemplating a primary care career, are "united by a new vision for revitalizing the primary care workforce pipeline" The organization has rapidly accrued over 3000 members (medical, nurse practitioner and physician assistant students, residents and those recently entering practice) in 40 chapters across the country. They offer training in leadership and grass roots advocacy for primary care.

AbsoluteCARE treats the "sickest of the sick": individuals that in the prior year cost the healthcare insurance system, usually Medicaid, over $80,000. With only 300 patients per team of physician, care coordinator and medical assistant along with social workers, nutritionists and mental health therapists, AbsoluteCARE has demonstrated that their model, while substantially increasing the costs of primary care, leads to much improved health parameters, greater patient satisfaction and a major drop in total healthcare costs-down more than one third off the former year's average costs. This is a unique approach. With this model, primary care is very expensive, but total costs come way down. The beneficiaries are not only the patient, but also the taxpayers who support Medicaid.

Another example is the Iora Health program in Atlantic City, NJ. For every 1200 patients there is a team of two PCPs, an NP, six health coaches, 2 administrative staff, plus a part time nutritionist, psychologist and social worker. There was a strong improvement in basics such as access to care, time and respect, communication with the patient and care coordination. Blood pressure and diabetes control improved, smoking rates declined from 21 to 11 (48%.) Total costs of care went down driven by large decreases in hospital admissions (41 per cent), ER visits (48 per cent) and outpatient procedures (23 per cent.)

These are examples where allowing adequate time with the PCP and his or her team can be highly beneficial. It costs more for this style of primary care but the results in quality and total costs are striking. The message is clear: comprehensive primary care is not only better care but it lowers total healthcare costs.



Copyright (c) Stephen C. Schimpff, MD