Covered Lives Under ACOs as well as the Number of ACOs is Growing

The number of ACOs rose from Q4 2010 to Q4 2013 from 41 to 606. During that time frame, the number of ACOs’ covered lives grew from 0.2 million to 18.1 million. Will the numbers continue to increase?

The Number of Uninsured Children In America is Declining

The percentage of uninsured children has declined since CHIP was implemented. Under the ACA, children are covered, even under dental insurance, under the more affordable of plans.

PCMH — Overcoming a shortage of PCPs

As we explored last week, the patient centered medical home (PCMH) is a concept that is quickly gaining popularity.   Through the use of sophisticated information systems and a strong primary care physician as a coordinator of a team of providers, PCMH has been proven to deliver reductions in cost and improvements in quality of care.

These demonstrations have been conducted in carefully controlled environments with providers and patients dedicated to its success.  The question remains: Can the PCMH successfully transition to settings that are less controlled?  If so, when?

Some of the challenges we’ve already described are: 1)  a lack of widespread implementation of electronic health records among primary care physicians, specialists, hospitals and other providers; 2) patient and specialist acceptance of the primary care physician’s role as the central coordinator of care.  (Note: Under the PCMH model, any physician specialty can act as the central coordinator of care.  However, for most patients, the primary care physician will take on that role.  For example, for patients suffering from primary immune deficiency, quite often the immunologist should act as the central coordinator of care.  But, for patients suffering from Crohn’s disease or ulcerative colitis, the primary care physician should act as the central coordinator of care once the condition is in remission.)

Today, let’s look at the next issue facing the patients centered medical home: a growing shortage of primary care physicians.  The American Association of Family Practice (AAFP) is predicting a shortage of 40,000 family physicians in 2020, when the demand is expected to spike. The U.S. health care system has about 100,000 family physicians and will need 139,531 in 10 years. The current environment is attracting only half the number needed to meet the demand.

One factor contributing to the shortage is that medical students are not opting for primary care, as illustrated below.

The PCMH will exacerbate the shortage.  Today, according to an article that appeared in The New England Journal of Medicine entitled “What’s Keeping Us So Busy in Primary Care?” on average each day, a primary care physician writes 17 e-mail messages , reviews 14 consultation reports , answers 24 phone calls, reads 11 imaging reports, and refills 12 prescriptions.  This is in addition to seeing at least 18 patients per day.

The PCMH will increase the primary care physician’s work outside of direct patient care.  A more formal process to coordinate care among various providers, even with the support of more sophisticated information systems, will require more phone calls, emails and report reviews.  This will necessitate the primary care physician decreasing their patient volume by more than 20%  For example, during the Group Health Cooperative’s experience published in 2009, primary care physicians decreased their patient volume from 2,300 per year to 1,800 per year.  Decreasing the primary care physicians patient volume will further exacerbate the shortage of primary care physicians.

Next week we’ll look at more challenges with the PCMH (eg, a growing shortage of primary care physicians).  But, more importantly, we’ll look at solutions to the issues we’ve identified.  AS the saying goes, nothing worthwhile comes easily.

Advertisement