Many health care “innovations” focus on a revitalization of primary care, ironically, while most of them (i.e., meaningful use) make being a primary care physician more miserable. A paper from PriceWaterhouseCooper’s Health Research Institute discusses the primary care “dream team” and how it could improve care and save money. (PWC Paper) The authors start by asserting that primary care should be viewed as a team effort, with the team including other clinicians such as nurse practitioners, physician assistants, behavioral health specialists, pharmacists, dietitians and therapists, social workers and health educators. They think that such teams could save up to $1.2 million for every 10,000 complex, chronically ill patient served. Uhhh, maybe, but if that is annual spending, it is $120 per patient, which isn’t much, and the net number appears to be $48, after the cost of creating and administering such a “dream team.” The broad team concept does make good sense, particularly for patients whose illness dominates their lives and who have multiple issues with basic needs, like housing, food, and transportation. And for certain patients, it could result in significant savings.
The report also segments patients and discusses the need to focus on the preferences of various segments, which also makes sense. The buckets are frail elderly, complex chronic, chronic disease, mental health, healthy families, healthy adult enthusiasts and healthy adult skeptics as patients. Obviously these are each going to have different interaction levels and types with the health system and also have different priorities in terms of what drives satisfaction with the system. One goal of the team-based approach is to allow physicians to focus on true medical needs and have other team members deal with appropriate aspects of a patient’s needs. The report goes on to spell out how various non-doctor team members could be used for each of the patient segments. There are currently a number of start-up primary care clinic companies, some aimed at specific markets like Medicare or Medicaid, and these companies are actively utilizing and refining new approaches to primary care. These real-life laboratories will provide very useful data on how to improve primary care for all patients.