At the Helm

Are you ready for the specialization of primary care?

by Rob Lazerow

Think of all the new things we are currently asking PCPs to do: Become a medical home. Manage high-risk patients differently. Offer on-demand access. Conduct e-visits.

Is it realistic for a PCP to do all of this at once—let alone effectively? Absolutely not.

Our research team spent the past year exploring the attributes of the clinician network that hospitals and health systems will need in the future. As you might expect, we found changes in care models and staffing needs looming in practically all specialties and settings. But nowhere were the changes more pronounced than in primary care.

Revising assumptions about the physician market

When we interviewed senior health system executives, we found that most were still building out their physician networks based on three outdated assumptions about the market.

First, they are assuming that the physician shortage is inevitable, despite the fact that new care models, technology, patient cost shifting, and provider-driven population health are all inflecting both provider supply and patient demand curves.

Next, they still assume that all roads to the patient run through the physician, even though new access points, narrower networks, higher deductibles, and the proliferation of mobile health apps are all reshaping how patients shop for care. In fact, the choices that patients make about their health insurance during open enrollment will drive both where and how they receive care across the year.

And finally, they are assuming that primary care remains a homogenous set of services that are delivered by generalist PCPs. And when we asked about primary care transformation, we generally heard about progress in transforming all primary care practices to medical homes. Yes, all of them—at least that’s the plan.

12 primary care pointers from peer executives

Segmenting PCP networks

By contrast, we are seeing progressive organizations starting to segment their primary care networks and assign discrete roles to specific providers. They are saying farewell to the generalist PCP model and embracing the specialization of primary care.

As we study how organizations are restructuring their primary care networks, we tend to see four new primary care identities emerge.

Super-PCP: Especially in rural areas and markets with limited supply of certain physicians, organizations are asking a subset of their PCPs to deliver an increasing range of services that have traditionally been the domain of specialists. For example, the University of New Mexico’s Project ECHO is upskilling PCPs so they can safely and effectively deliver specialty services. And so far, the quality of care delivered by these PCPs is just as high as their specialist counterparts.

Even if you are not in a rural area, this might be a worthwhile tactic to help specialists in your network practice at the top of their training—not to mention capitalize on the beneficial labor cost differential if your network employs the physicians in question.

Complex care manager: When developing a population health strategy, one of the first steps is to deploy a high-risk care management model to support your sickest patients since they account for an outsized proportion of health care spending.

We have seen several approaches, but some organizations are choosing to re-panel their highest-cost patients to dedicated high-risk clinics. For example, the PCPs practicing at AtlantiCare’s Special Care Center focus exclusively on managing the system’s sickest patients. Specialization is critical to the model.

Care team director: While high-risk care management is the right approach for your sickest patients, few systems can afford to replicate this expensive model for their healthier patients. So for the rising-risk population, the patient-centered medical model home offers a more scalable approach.

But the key is that not every practice needs to become a medical home—primarily just the ones treating your rising-risk patients. And when designing the medical home staffing model, organizations need to carefully craft each care team member’s role to manage labor costs and enable panel growth.

For example, Stanford Hospitals & Clinics clearly delineates the roles of PCPs, nurses, and medical assistants. PCPs principally serve as care team directors and focus on developing the care plan, managing the practice team, and collaborating with specialists.

Concierge care provider: Patients are increasingly seeking on-demand primary care and e-visits, often prioritizing convenience and affordability as they actively shop for care. Although non-traditional competitors are investing in storefront clinics—including CVS, Walgreens, and Walmart—hospitals and health systems are beginning to compete more aggressively in this new market for on-demand care.

There are several ways that hospitals and health systems can task a subset of their PCPs with providing on-demand access. For example, North Shore Medical Group (part of Partners HealthCare) collaborates with MDVIP to offer patients a personalized concierge option. And Sentara Healthcare partners with MDLIVE to bring real-time e-visit capabilities to the system. In each case, a select number of physicians staff the programs.

The PCP network of the future

As hospitals and health systems advance their care management capabilities and compete in the new retail market, they will continue to need their primary care networks to deliver a wide range of services.

Based on our research, we expect that most successful organizations will combine the four identities outlined above to build a tiered primary care network. Beyond crafting the network itself, leaders will also need to address the challenge of helping PCPs find their role in this emerging structure. But at the end of the process, health systems will have managed a significant cultural and clinical transformation—the specialization of primary care.

Design the cost-effective clinical workforce

Check out our research briefing to learn how to build a clinical workforce that can deliver efficient acute care, cost-effective care management, and on-demand patient access.