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'Is primary care as we know it dead?' The question that stopped me in my tracks.

By Rachel Woods

March 4, 2020

    Welcome to "Field Report," a new series where Advisory Board experts weigh in on what they are hearing from health care organizations across the county. In this edition, Rachel Woods explores the future of primary care—and why medical groups and health systems should break the one-size-fits-all primary care model.

    New report: The future of primary care

    Rachel Woods
    Rachel leads research and collaborates with executive teams on key issues like physician alignment, primary care transformation, and consumer strategy.

    A few weeks ago, research teams at Advisory Board held a medical group executive retreat to discuss the future of primary care with leaders of employed and independent medical groups from across the country. In our opening session, I was struck by a blunt but telling question from one of our audience members.

    'Is primary care as we know it dead?'

    We opened our session by discussing the challenges of primary care today, which, according to a recently completed study by one of our research teams, are significant.

    Despite all the investments organizations have made to improve access, elevate experience, reduce burnout, and lead care transformation, primary care is—by many metrics—actually worse off in 2020 than it was five years ago. Wait times are up, net promoter scores are down, and nearly half of primary care physicians classify themselves as burned out. But at the same time, purchasers of all stripes are looking to primary care as the key to meeting the affordability mandate through preventive care, reduced utilization, and referral management.

    In response, one brave audience member raised his hand to address his peers: "I just want to ask a blunt question—is primary care as we know it dead?"

    The question was followed by an audible (yet comical) gasp from leaders around the room. But it also garnered several nods and attentive looks. The question was blunt, but it was also spot-on.

    How third-party disruptors are forcing us to re-think primary care

    The discontent among primary care consumers and physicians has fueled an entirely new part of the health care industry, one that incumbents have largely ignored.

    Players like ChenMed, One Medical, and Iora Health—among countless others—have developed different-in-kind models that appeal more directly to both patients and physicians.  

    These new models cater to very specific slivers of the patient population by striking a balance between delivering a scoped product and solutions that deliver at scale. Some competitors are laser-focused on meeting the needs of complex populations and have an operating model to match—focusing on things like small panels, a broader care team, and high-touch coordination.

    But others are targeting younger, healthier patients, usually with commercial insurance. Because these models are focused on scale, patients may not have a dedicated primary care physician. In fact, patients might not see a physician at all, and instead could be treated by a nurse practitioner or physician assistant. Scaled solutions require significantly higher panel sizes, and to get there groups are pairing an expanded care team with a heavy dose of technology and artificial intelligence to maximize efficiency.

    This is a pretty stark contrast to how traditional organizations approach primary care. However, bucking tradition may be what is at the heart of our audience member's question, the answer to which emphasizes the need for medical groups to break with tradition and commit to delivering a different-in-kind-primary care product—one that requires a different care team model, technologically enabled practices, and new approach to provider compensation.

    As we redefine what primary care should look like in the future, it's time to leave the one-size-fits-all model in the past. Instead of focusing on one-off solutions to access or experience, leaders must redesign their primary care product to meet the needs of patients as well as providers while delivering on the drivers of affordability.

    So I want to reframe the original question. It's not "is primary care dead?" But rather, "Should primary care as we've known it be a thing of the past?" To that, I say a resounding yes.

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