There are powerful reasons to move to a value-based primary care system. Highly effective primary care is an indispensable piece of that effort. It is critically important that we move rapidly from Primary Care 1.0 and 2.0 to Primary Care 3. The latter provides a molecular medical management framework as opposed to the traditional organ system management. We believe that implementing this type of approach will unlock the full potential of primary care.
Why is primary care so important?
Research demonstrates that a focus on primary care has many benefits. These include:
- better health
- lower costs
- lower mortality
- higher patient satisfaction
- fewer ER visits
- reduced hospitalizations
Primary care provider reimbursement generates just 7.7% of healthcare costs but PCPs direct most spending through their referrals. There is evidence that this is exacerbated when PCPs are employed by hospital systems.
It is important to recognize that the costs of care are not distributed evenly:
- Ninety percent of the nation’s healthcare expenditures are for people with one or more chronic conditions. Further, forty-one percent of costs are tied to just 12% of the population that has 5 or more of them.
- Just 5% of patients generate over half the costs. This is, in part, because they don’t receive effective primary care upstream to reduce serious comorbidities downstream.
An interesting twist is that primary care has already begun to segment. For example, urgent care providers and hospitalists are organized to meet the specific needs of people with acute or intensive needs. In addition, some primary care providers are specializing in delivering care almost exclusively via telemedicine. Primary care teams that focus on chronic conditions are critical to improve overall health and save money.
Stages of Primary Care for cardiometabolic disease
Let’s look at the different stages of Primary Care using the management of cardiometabolic disease as an example.
Primary Care 1.0
In primary care 1.0, physicians practice what is called “usual care.” They manage chronic conditions, such as the prevention and management of chronic kidney disease (CKD), using any medication that has been approved for the purpose. They may not specifically take into account the molecular medicine and the root causes of the condition.
Many of these patients are diabetic and hypertensive. Aggressive treatment of these conditions is needed to prevent the development and progression of kidney disease to end-stage renal disease requiring dialysis.
Related Content: A PCP Imperative: Integration of Behavioral and Physical Health Care
In addition, socioeconomic factors also play an important role. The cost of care can be a huge barrier to effective primary care access not only for the uninsured but also for the under-insured and those with high cost-sharing plans.
For people who can gain access to current primary care, treating hypertension and diabetes in usual care can be effective in preventing progression to dialysis. However, depending on which drugs are chosen to manage them, costs of care can vary widely.
Consequences of failure to prevent progression of CKD
Failure to prevent the progression of CKD poses significant health risks for patients. For example, one study found that “cardiac and vascular mortality are several times higher in dialysis patients than in the general population.”
Further, progression to dialysis is very expensive. The diabetic patient without CKD costs $10,721 annually. With stage 3 CKD and any progression, the cost is $31,693. The dialysis patient costs $62,091 a year.
Once a patient goes on dialysis, they automatically go on Medicare.
Even if you are miserly and hard-hearted…even if you care nothing for the plight of people less fortunate than you… you are going to pay for their much more expensive care down-stream.
It is in everyone’s hard financial interest to see that every American has access to cost-effective primary care, including critical generic medications.
Primary Care 2.0
As effective as Primary Care 1.0 is, it does not begin to r