Tapping into the full potential of primary care providers will mean the U.S. healthcare system investing more in new payment models and the workforce in general.
Time and time again, primary care has shown it’s importance to the health and well-being of patients. In fact, it’s the only part of healthcare where an increased supply leads to better population health and more equitable outcomes, said Dr. Christopher Crow, the CEO with Catalyst Health Group. “That’s because primary care providers have an opportunity to help patients earlier, explore their health in a deeper way and support them over the full course of their lives,” he said.
Dr. Crow is a founding partner of Primary Care for America, (PCfA) a collaboration focused on demonstrating the value of primary care, the need for increased primary care investment and the importance of innovation in primary care delivery and payment models. PCfA is comprised of a diverse group of key partners in the American health care industry: agilon health, Aledade, American Academy of Family Physicians, American College of Physicians, Catalyst Health Network, ChenMed, Elation Health, Everside Health, MDVIP, One Medical and VillageMD.
In the following interview, Dr. Crow provided his thoughts on how the U.S. healthcare system can better prioritize primary care, the importance of supporting new models of care, the current state of the primary care workforce, and more.
Repertoire: How do we better prioritize the role that primary care physicians play in patient health and wellness?
Dr. Christopher Crow: We have to start by recognizing once again that primary care is about more than just access and convenience. Primary care should be far, far more than a transactional experience. In fact, primary care has shown time and time again to be the only part of healthcare where an increased supply leads to better population health and more equitable outcomes. That’s because primary care providers (PCP) have an opportunity to help patients earlier, explore their health in a deeper way and support them over the full course of their lives.
But to empower PCPs to do that, we have to support new models of care, starting with changing payment structures. By shifting from the standard fee-for-service model to value-based care with a prospective payment model, PCPs can focus more on delivering personalized care to each patient … rather than constantly having to worry about the volume of patients they can see each day. And then we can support this model further by arming PCPs with technologies that connect the care experience and teams of care coordinators, pharmacists, social workers and more – all of whom can deliver specialized expertise in the moments that matter most.
Repertoire: How do payment models factor in? How do we reduce fee-for-service and promote other models, and what are some examples of those other models?
Dr. Crow: Payment models are the key. It’s completely naïve to expect anyone to work for extended periods of time against their own financial best interests. But that’s exactly what we expect from PCPs in our current system. If we want that to change, we need to change the incentive structure and move away from a system that disproportionately rewards volume over value.
Specifically, we need to move to value-based constructs that include prospective payment as a core element. Doing so will encourage PCPs to prioritize relationship-driven care for their patients. When PCPs don’t have to correlate the number of appointments in their days with their financial stability and success, they’re freed from the hamster wheel. Instead, they can form longitudinal relationships with patients and lean on their extended teams to support patients at each step. We see this evolution from transactional experience to more of a holistic, subscription experience in so many other parts of our lives – from movies, to music, to fitness and more. In every instance, it’s created an improved consumer experience. It’s time for that in healthcare as well.
Repertoire: What does the current primary care workforce look like? What is its current trajectory? And how do we improve it?
Dr. Crow: To be blunt, the current state of the primary care workforce in the U.S. is declining, with turnover causing nearly $1 billion in excess spending. Here in Texas, we’re seeing a shortage that far exceeds the rest of the nation. In the U.S. there are 156 PCPs per 100,000 lives. In Texas, the coverage is less than half of that, 74 PCPs per 100,000 lives.
Unless we can make primary care more economically viable and give PCPs the support they need, we’ll see the number of PCPs continue to decline and in frightening ways. We improve that by creating better answers for struggling providers: payment models that align better care with better economics; technologies and teams to help PCPs know that they don’t need to do everything on their own; more visibility to the viability of primary care as an attractive field that gives providers the daily opportunity to connect with patients and make an enduring impact on their health.
Once again, the prospective payment model would allow teams and technologies to scale PCPs and help them meet the supply and demand issue we face, all while leading to better outcomes. These outcomes include provider satisfaction, which would also improve the supply demand challenges over time.
Repertoire: What are some examples of innovation in primary care that is changing local communities for the better?
Dr. Crow: When the COVID-19 pandemic hit, we saw the rise in telehealth services as a viable option for healthcare and an equitable route to providing primary care. Telehealth allowed physicians to provide care to people who faced barriers to care. However, care can’t exist solely through virtual interactions because not every condition can or should be addressed through virtual appointments. PCPs need to adopt an omnichannel model that combines the accessibility of telehealth with in-person care to build meaningful relationships with patients in ways that fit patients’ lives.