“It’s much more important to know what sort of patient has a disease than what sort of disease a patient has.” -William Osler, Father of Modern Medicine

Primary Care physicians’ role as lead counselors and navigators is changing. When Emergency Rooms replaced physicians, because it has predictable hours and no payment barriers, costs skyrocketed. Policy makers and insurers winced. As a result, health reform, PPACA in 2009 and HCERA in 2010, includes multiple strategies to move patients away from expensive care sources. Care management models are encouraged and will be tried, funded, evaluated and challenged.

Provider-consumer relationships, electronic health records, chronic disease care management and changed incentives dominate the models. Accreditation bodies, NCQA, URAC and the Joint Commission, are defining Primary Care Medical Homes (PCMH). Pharmacies are adding clinics; insurers and others are building in-house primary care systems, using nurse managers and navigators. States are encouraged to experiment. So, models differ across state lines. In 2011, despite small incentive arrangements, primary care providers will remain underpaid and shortages are predicted.

Accustomed to on-demand services, customers are creating their own work-arounds.

PDA Primary Care offerings include:

• Briefings on new primary care models
• Impact analysis
  • Emergency departments
  • Primary care and physician networks
  • Hospital inpatient and outpatient services
  • Pharmacy
  • Behavioral health
  • Long term care
  • Specialist referrals
• Facilitation for transition to medical home and patient-centric models
• Outcome-based incentive payment system for primary care providers
• Facility space retrofit for customer centered, medical home

Primary Care Experience