If I were a medical student today…

Scott Eathorne, MDMedical DirectorProvidence Medical GroupPartner 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” 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

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

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

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

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

And the answer…

YES! But what to tell the kids?? And who will take care of me??