Transforming Primary Care

Topics: Primary Care, Physician Issues, Accountable Care, Market Trends, Strategy, Health Care Reform, Clinical Integration, Hospital-Physician Alignment, Medical Home

After reading this study, members will understand:

• Why there is a renewed focus on primary care and how its value proposition to hospital and health systems is evolving
• What the medical home model is and how primary care practices should implement it
• What the main options for assembling a physician-led primary care team are
• How primary care physician compensation is evolving to support enhanced care delivery
• How primary care practices are leveraging payment incentives, from fee-for-service to enhanced reimbursement models, to support practice transformation

Executive Summary

A renewed focus on primary care
Strong alignment with PCPs—with the hope of growing a robust referral network—will remain a priority for hospitals regardless of their accountable care strategy. However, hospitals cannot form ACOs without primary care physicians on board as true partners, willing to set a common vision for creating a comprehensive care delivery system—and capable of playing a central role in managing the cost and quality of the care they deliver. If ACOs are to be successful, effective primary care must be the linchpin, taking the lead in delivering enhanced access, comprehensive and coordinated care, proactive chronic disease management, and patient education.

Assembling a high-performance primary care network
Growing and organizing PCP practices for optimal performance is essential for laying the groundwork for broader practice and care delivery transformation. Hospitals must assemble a high-performance primary care delivery network by creating a compelling value proposition that attracts and retains the best PCPs and allied clinical team members. Primary care team members, ranging from mid-level practitioners to registered nurse and medical assistant health coaches, practicing "at the tops of their licenses" are essential for comprehensive care delivery because PCPs will be unable to take on additional medical home tasks and services alone.

Transitioning practice operations
In transitioning primary care practices to the medical home model, practices must reorient visits around comprehensive and standardized care delivery to make each patient encounter most effective. Care teams need to use a disease registry to facilitate patient management and leverage health coaches to educate patients and engage them in self-management. Practices should also enhance patient access, by improving scheduling and expanding hours, as well as exploring retail clinic integration and remote visits, in order to prepare for health insurance coverage expansion in the immediate term and support panel size expansion in the longer term. Additionally, practices must improve cross-continuum coordination with specialists and the hospital via integrated referral and discharge protocols.

Creating a sustainable financial model
Of course, transforming primary care must be done in a financially sustainable way. As primary care practices move toward medical home and, potentially, accountable care payment models, PCPs will need payment incentives that reward a new set of primary care performance metrics. This requires starting from a baseline position of stable primary care practice economics, and then evolving employed PCP compensation to incentivize new primary care performance competencies. More broadly, primary care medical practices can be supported by a range of payment models, from using the medical home itself to improve practice profitability under the existing fee-for-service payment system to increasing practice revenue by leveraging additional reimbursement incentives.

Access the full study for more information
This study, Transforming Primary Care: Building a Sustainable Network for Comprehensive Care Delivery, provides hospital and physician executives with guidance on how to enhance their primary care delivery, covering 22 key lessons for assembling a high-performance primary care network, transitioning practice operations, and creating a sustainable financial model.

A Renewed Focus on Primary Care