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If I were a medical student today…

If I were a medical student today…. Scott Eathorne, MD Medical Director Providence Medical Group Partner Health. Would I still go into Primary Care?. Then and now: the ’80’s and today Idealism and Realism: “It’s not, or at least not initially, about the money”

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If I were a medical student today…

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  1. If I were a medical student today… Scott Eathorne, MD Medical Director Providence Medical Group Partner Health

  2. Would I still go into Primary Care? • Then and now: the ’80’s and today • Idealism and Realism: “It’s not, or at least not initially, about the money” • Primary Care “Motherhood and Apple Pie” – The PCMH • Personal physician: PCP, selected specialists • Physician directed medical practice: team based care • Whole person orientation • Care that is coordinated and/or integrated: Wegner’s Chronic Care Model • Quality and safety • Enhanced Access: “the right care at the right time and place” • Payment

  3. Then… • More care, less paperwork (although the HMO looming large…) • Be your own boss (but physician employment on the rise…) • Everyone provided outstanding care (no consistent performance reporting, certainly not public) • Demand for primary care (a buyer’s market – “Gatekeepers Needed”) • “Doctor knows best” patients • Reasonable pay

  4. And now… • Mounting “paperwork” (referrals, prior authorizations, performance reporting) • Transitional payment chaos (FFS to Capitation to P4P) • Constant “transformation”: (Pursuing the PCMH) • Profiling and Performance Reporting (maybe my care isn’t outstanding) • Educated patients (sometimes demanding) • Declining volumes from lost coverage (but anticipated demand – The Aging Boomers) • Overall declining pay and the need to pursue other revenue streams

  5. The Opportunity • Leadership in the evolving healthcare paradigm • From “Gatekeeper” to “Partner in Health” • From episodic care to population management • Equal parts art and science (Marcus Welby with a computer) • Demonstrated excellence and value • Creating Accountable Care Organizations – moving PCMH beyond PCP office to engage specialists, hospitals, and other care providers • Payment models that adequately reward the pivotal role of PCP

  6. The Risks • Systemic adoption of PCMH does not occur (and promise of improved quality/safety at lower cost not realized) • Inability to effectively engage all care providers • Consumers don’t value the new care model (I want the care I want, when and where I want it) • Payment reform doesn’t occur in a meaningful way (continued incentives toward procedural work, episodic care) • Consumers aren’t engaged through benefit design to change

  7. And the answer… • YES! • But what to tell the kids?? • And who will take care of me??

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