Primary care regains momentum amid innovation
This article is Trend No. 2 of 5 in Drug Store News' overview of the current state of the healthcare market.
The family doctor is back. Driven by the funding priorities of health reform under the Affordable Care Act — and by the recognition among federal and state health plan administrators and payers that primary care teams represent the nation’s most cost-effective source of patient care — primary care physicians once again are moving to the center of American health care.
That, at least, is the conclusion of the latest report from PwC’s Health Research Institute on U.S. healthcare trends in the wake of the full implementation of the ACA. The report tracked a national shift “back to healthcare basics” as the health delivery system realigns itself to the new reality of medical homes, accountable care, risk- and evidence-based payment models and team-based patient care.
“If the ACA is a balance between expanding insurance coverage and encouraging non-traditional ways to pay for and deliver medical services, then primary care is its fulcrum,” PwC reported. “From treating the millions of newly insured Americans to testing novel ways to manage and streamline care, physicians broadly — and primary care clinicians specifically — are integral to virtually every initiative written into the law.”
This “back to basics” movement is fueled by “experimentation in new payment models and expansion of insurance coverage,” which “are making primary care once again the critical touchpoint,” PwC noted. Bolstering that shift are “new risk-based payment models [that] allow physicians to share in a percentage of the savings generated by more streamlined care.”
But the resurgence of primary care doctors also is made possible by the rise of accountable care organizations and team-based care networks, and by the pharmacists, nurse practitioners and physician assistants who supplement and extend the care provided by overstretched physicians and improve access to care for tens of millions of Americans, PwC reported.
“Primary care teams — including physician ‘extenders’ with their ability to deliver routine medical care while steering sicker patients to specialists — have long been seen as the best value across the U.S. health system,” the report stated. “In addition, greater use of telehealth and extenders … help to meet the growing demand for care as the number of newly insured continues to rise.”
“The ACA recognized this, requiring that health plans cover primary and preventive care as essential health benefits, dedicating billions more in payment to keep physicians engaged with Medicare and Medicaid, and providing incentives to sway budding doctors to practice primary care,” the report noted.
Indeed, PwC reported, “The ACA dedicates more than $31 billion to boost primary care” through several ventures, including:
$11 billion over five years to operate, expand and build a network of health centers to boost access to primary care in underserved areas;
$10 billion over a decade to the Center for Medicare and Medicaid Innovation to “fuel exploration of new ways to deliver and pay for quality care, including primary care specifically,” according to the HRI. The center has spawned a number of collaborative-care pilot programs involving pharmacies, and has become a focal point for efforts by chain and independent pharmacy advocates to boost pharmacists’ professional status and reimbursement for clinical and preventive-care services;
$5.6 billion in additional funding for Medicaid reimbursement for primary care services;
$3.5 billion in additional Medicare bonus payments to primary care doctors; and
$1.5 billion in career incentives to encourage new primary care physicians to practice in underserved communities.
The goal: “To keep primary clinicians engaged and increase consumers’ access to their services,” according to PwC.
Among its other effects, the ACA “also created a new lexicon for doctors,” the HRI report stated. “Concepts such as ACOs, bundled payments and population health … dominate the discussion among industry executives.”
The shift to new, evidence- or risk-based payment models for primary care physicians and accountable care organizations will reach a crescendo by 2018, when the federal government plans “to tie half of providers’ Medicare reimbursement to alternative payment models,” PwC reported. “The challenge for primary care now is to strike the right balance between old and new, easing the learning curve associated with the inevitable switch to a value-based system without leaving money on the table in a still predominantly fee-for-service world.”