Primary Care Makeover

Primary care has gotten exceptional attention as the pivot point for improvement in health care quality and spending, which makes the contrarian in us wonder if that is really the case.  PriceWaterhouseCoopers’ Health Research Institute certainly believes in primary care, although saying it needs a “makeover”.   (PWC Report)   The report is based on interviews with thought leaders and surveys with doctors and patients.  According to the respondents, payers are counting on primary care to save money and are willing to pay for lower cost options, like retail clinics and telemedicine.  Consumers are more willing to consider these options rather than a traditional family doctor.  New entrants are being “disruptive” (gag me) by offering convenience, house calls, digital health and nurse alternatives.  Existing practices are adopting new models to preserve share.  There are seven consumer primary care submarkets emerging.  Blah, Blah, Blah and other consultant-speak.

CVS Health is profiled for its retail clinic model, which is expanding to include telehealth, infusion services and chronic disease care.  One Medical offers a new primary care model in which physicians see about half the typical number of patients per day, charge a modest annual fee to patients to support wellness and other services not covered by insurance and claims to have one-third the operating costs of traditional practices by use of technology and a “patient centric” design.   Not too believable.  Then there is Iora Health, another primary care model which focuses on intense patient management and relationships.

Primary care can be a valuable channel to manage patients carefully.  But in some cases specialists may actually understand a patient’s needs better and may be able to manage their care more efficiently.  And many consumers seem more interested in a quick pit stop at the ER or urgent care or a fast online, video or phone consultation than building a lasting relationship with any doctor.  And as usual, the evidence that medical homes, telehealth and other forms of “madeover” primary care save money or improve health outcomes over the long haul is pretty skimpy at this point.