Comparisons of Restructured Primary Care

1. Comparisons of Restructured Primary Care A Synthesis

2. Common Themes • Shortage of primary care “providers” • Geographic variability • Variability in the types of and numbers of primary care providers • Challenges with fragmentation of care, coordination of care, reliable access to vulnerable groups, diminished emphasis on health promotion and disease prevention

3. Common Themes • Introduction of interdisciplinary teams • Better use of information technologies • Challenges with forms of reimbursement for providers • Work life balance – especially for those in remote areas • “Turf” battles • Use of physician extenders

4. Common Themes • Experimenting with new models of care • Present, but potentially diminishing emphasis on the role of the physician • Quality improvement/cost savings associated with effective provision of primary care • Physician provider shortages? • Variation in practice patterns for physician extenders

5. Common Themes • Relatively low physician reimbursement as compared to specialist physicians • Efforts at implementing the Patient Centered Medical Home • Variability in the skills of primary care providers • Recognition of the value of evidence based medicine with less than application

6. Common Themes • Need for innovation and concomitant resistance to innovation • Inability to effectively assess the value of new models of care • Variable funding priorities • Similar demographic challenges • Unsustainable economic challenges

7. Differences • UK, Canada, Australia with significant government involvement associated with universal approach to care based on a primary care model • US lacks universal care approach and is far more specialty driven • Physician extenders in UK, Australia, and Canada with higher utilization in primary care

8. Differences • Physician extenders in the US with significant migration into specialty and or hospital based practices • Challenges for role modeling for primary care physicians in US academic health centers • Significant medical student debt in the US drives specialty choice • Role of the Relative Value Update Commission (RUC) in the US

9. Differences • Role of the fee for service approach in the US

10. Questions for the Breakout Helene: • Who or what are the range of health care providers engaged in the provision of primary care? • How are these groups of providers managed • If team based care has been implemented, what is the evidence that efforts have been successful?

11. Questions for the Breakout Bob: • What are the barriers to expanding the networks of providers of primary care? • Are there any levers to rapidly implement change? • Are there “turf” battles and if so, are there reasonable solutions?

12. Questions for the Breakout Lucio: • Are there effective systems in place to appropriately reimburse primary care providers? • If so, how are they managed (i.e. bundled payments, capitation etc)? • Are there providers of primary care who do not expect to be compensated?

13. Questions for the Breakout UK Discussant: • Are there emerging systems of primary care that are developing beyond the medical mainstream and if so, describe them and if possible, their effectiveness? • If there are emerging systems, are there forms of collaboration with traditional networks of care?