The value added by primary care - not yet a game-changer

By Albert DiPiero MD MPH

The long debate about the true value of primary care continues. In the US, healthcare is organized around expensive hospitals and specialists. In most other countries, care is focused around outpatient generalist primary care providers. Does having a dedicated source of primary care lead to improved care and better value. That is the question this large, well designed study tried to answer by extracting and studying data from national surveys of over 70,000 people conducted between 2012 and 2014. Very briefly, people with a primary care provider seem to receive more high-value care in some categories, about the same amount of low-value care as those without a PCP, and they have higher positive experience. There is a lot to unpack here. Please read the entire study. But do these results merit changing policy to fund and encourage primary care? I think it depends on what is meant by primary care and what we are trying to optimize. In my reading, the results are positive but not overwhelming in favor of primary care. In addition, the study focuses on a very traditional definition where a respondent can name a specific provider as their usual source of care, ignoring how care is now a team sport. An accompanying editorial astutely points out that:

“Most of the quality process measures that showed significantly better performance do not require physician-level input, and those that do require it seem to fall short (eg, heart failure, asthma, and COPD care and antibiotic use) or prove no better (eg, low-value imaging, low-value medical treatment, emergency department use, and hospital admissions).”

Furthermore, ... “these results suggest primary care physicians are spending most of their time arranging prevention, performing screening, and offering counseling while their physician-level diagnostic and management skills seem to go unused…”

What does this mean for the entrepreneur? It is critical to focus on what goal one is targeting and not get side-tracked by labels, such as PCP. Care will definitely move from the hospital to the “phone” and to the home. This represents a massive opportunity for the innovators and the policy makers who are willing to deconstruct care, develop ways for non-physicians to provide care, move care outside of the hospital and the clinic, and develop novel payment structures that reward the right results.

Read JamaNetwork: Quality and Experience of Outpatient Care in the United States for Adults With or Without Primary Care

Read JamaNetwork: Does Primary Care Add Sufficient Value to Deserve Better Funding?

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