Implementing High-Quality Primary Care Rebuilding the Foundation of Health Care (2021) / Chapter Skim
Currently Skimming:
1 A New Vision for Primary Care
1 A New Vision for Primary Care
Pages 19-44
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 19... ...
High-quality primary care is a critical component to achieve the quadruple aim of health care -- enhancing patient experience, improving population health, reducing costs, and improving the health care team experience -- and it can both make health care more personal and address the inequities that currently plague the U.S. health care system (Bodenheimer and Sinsky, 2014; Christian et al., 2018; Kringos et al., 2013; Macinko et al., 2003; Park et al., 2018; Phillips and Bazemore, 2010; Starfield et al., 2005)
|
From page 20... ...
Primary care data include physicians in family medicine, general practice, geriatrics, general internal medicine, and general pediatrics only. Nurse practitioner, physician assistant, and midwife data were not broken down by setting and are not represented in this figure.
|
From page 21... ...
. The upshot of this underinvestment in the United States is a disjointed health care enterprise that creates inequities in care, misallocates resources between primary and specialty care, burns out clinicians, generates financial pressure on primary care practices, limits the relationships that clinicians and patients can develop, produces suboptimal care for too many U.S.
|
From page 22... ...
. Primary care visits by commercially insured children and adolescents have also fallen by approximately 13 percent over the same period, with problem-based visits dropping 24 percent and preventive care visits increasing 10 percent (Ray et al., 2020)
|
From page 23... ...
Meeting participants included a diverse set of stakeholders and primary care experts, including representatives from government agencies, international health organizations, private foundations, academic institutions, primary care researchers, interest groups, and a member of the committee that authored Primary Care: America's Health in a New Era (IOM, 1996)
|
From page 24... ...
. BOX 1-1 Study Sponsors • Academic Pediatric Association • Agency for Healthcare Research and Quality • Alliance for Academic Internal Medicine • American Academy of Family Physicians • American Academy of Pediatrics • American Board of Pediatrics • American College of Physicians • American Geriatrics Society • Blue Shield of California • The Commonwealth Fund • Family Medicine for America's Health • Health Resources and Services Administration • New York State Health Foundation • Patient-Centered Outcomes Research Institute • Samueli Foundation • Society of General Internal Medicine • U.S.
|
From page 25... ...
needed to evaluate effectiveness of innovation and its impact on health outcomes and to support data-informed decision making. To develop the implementation plan, the committee will consider successes and limitations of prior efforts to innovate in primary care, as well as the increas ing demands and stresses on the primary care system, and will recommend ways to effectively scale and implement successful innovations and programs in U.S.
|
From page 26... ...
Additionally, while the following chapters discuss the roles and responsibilities of many of the professions that can be part of an interprofessional primary care team, it was beyond the scope of this report to define these roles for every profession in the context of primary care delivery. Similarly, challenges and arguments around scope of practice issues for the various professions in primary care have been the focus of other National Academies reports (IOM, 2011a,b;
|
From page 27... ...
-- were foundational and influential works that represented an ambitious plan to strengthen primary care in the United States. These reports defined primary care as "the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community" (IOM, 1994, p.
|
From page 28... ...
The committee developed this report and its recommendations and implementation strategy with these barriers in mind. A 2012 report, Primary Care and Public Health: Exploring Integration to Improve Population Health (IOM, 2012b)
|
From page 29... ...
Given that this committee's charge was to develop an implementation plan to improve primary care, the committee acknowledged the difficulty of developing specific strategies that would depend on a wide array of independent or poorly coordinated stakeholders and organizations and strongly agrees with the 1996 committee's idea that such an organization would help facilitate needed changes. Building on the 1996 recommendation, this committee proposes a more targeted, specific approach to ensuring that improvement efforts are coordinated and that stakeholders in the field are held accountable (see Chapter 12)
|
From page 30... ...
The Patient Protection and Affordable Care Act6 passed in 2010 enabled many previously uninsured Americans to obtain health insurance and did strengthen primary care in many ways (Davis et al., 2011) , but it still fell short of the original 1996 recommendation for universal coverage.
|
From page 31... ...
, was advanced as a solution to implementing many of the goals of the 1996 report. The PCMH model combines the essence of primary care with innovations to better align care processes with patient needs.
|
From page 32... ...
In fact, despite repeated recommendations to realign graduate medical education (GME) funding and accountability to focus on primary care and population health (COGME, 2010; IOM, 1989, 2014)
|
From page 33... ...
Lack of a Primary Care Research Agenda PCR is a distinct and unique area of scientific inquiry. It includes novel approaches to acute, chronic, and preventive care in the context of wholeperson care; developing and improving systems of care; disseminating and implementing evidence-based care; addressing behavioral health and SDOH as part of care; using technology for care; and uniquely blending individual care and population health.
|
From page 34... ...
, primary care encountered similar hikes in administrative and personnel costs without comparable increases in payment rates. This left little or no choice for many small, independent primary care practices other than purchase by larger, for-profit health systems, which enabled them to increase rates for delivering essentially the same services (Mostashari, 2016; Scheffler et al., 2018)
|
From page 35... ...
Such arrangements, which are the predominant payment method, have jeopardized the very existence of many primary care practices because the volume of visits declined rapidly as the pandemic took hold (Basu et al., 2020; Phillips et al., 2020)
|
From page 36... ...
. The combination of events directly speaks to the committee's Statement of Task, particularly in terms of achieving health equity and population health goals and improving access, especially for underserved populations.
|
From page 37... ...
Chapter 9 discusses the critical role that revamping the current payment system can play in creating a system that can support independent primary care practices and the emerging array of new primary care delivery models. Chapter 10 makes the case for why the nation needs to invest specifically in PCR rather than relying on research in subspecialty care, hospitals, or singledisease cohorts.
|
From page 38... ...
2016. Effects of new funding models for patient-centered medical homes on primary care practice finances and services: Results of a microsimulation model.
|
From page 39... ...
2017. Costs of transforming established primary care practices to patient-centered medical homes (PCMHs)
|
From page 40... ...
1989. Primary care physicians: Financing their graduate medical education in ambula tory settings.
|
From page 41... ...
2012. Small primary care practices face four hurdles -- including a physician-centric mind-set -- in becoming medical homes.
|
From page 42... ...
2016. Implementation of an inter disciplinary, team-based complex care support health care model at an academic medical center: Impact on health care utilization and quality of life.
|
From page 43... ...
2020. Quick COVID-19 primary care survey: Clinician series 9 fielded May 8–11, 2020.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.