The Patient Protection and Affordable Care Act reconfirms that healthcare delivery is shifting towards primary care. Primary care physicians are in the best position to expand access under coordinated healthcare and assume the role of care managers. Hospitals need to create a primary care infrastructure in order to move forward under reform.
Health Strategies & Solutions, a Philadelphia-based national healthcare strategy firm, recently authored a white paper that gives six imperatives the healthcare executives must address as they plan and develop their primary care infrastructure.
1. Manage risk payments. Traditionally, compensation for primary care physicians was fixed or based on production. Now, as the responsibility for care management increases under reform, so does the portion of risk, according to the white paper. To prepare to manage risk in the short term, the white paper recommends hospitals partner with payors to assume more accountability for quality and outcomes, so PCP compensation increases. Also, hospitals can incorporate an integrated electronic health record to facilitate coordinated care and evidence-based clinical protocols for patient conditions with the highest utilization rates.
2. Achieve performance improvement and financial viability for employed PCPs. As budgets continue to become constrained and physician employment continues to rise, organizations need to learn how to employ physicians at lower subsidy levels and improve physician performance. In the short term, organizations can place a greater portion of PCP compensation at risk, to be earned by increased productivity and improved quality and cost control, and can identify and quantify high-return performance improvement initiatives.
3. Determine primary care network size, mix and geographic distribution. As the role of PCPs change, the correct number, mix and geographic distribution of PCPs changes for organizations. The need for primary care physicians is on the rise, with their increased role in care management and the aging of the general population, according to the white paper. Currently, the number of PCPs needed per 100,000 population is 60 to 80, but that is expected to increase by 20 percent in many markets. Therefore, hospitals need to determine what an adequately sized and geographically distributed network of PCPs would be for their area.
4. Implement primary care recruitment and retention strategies in highly competitive markets. With the increase in physician employment and the shortage of physicians, recruiting and keeping physicians will become more difficult and competitive, according to the white paper. Therefore, retention of physicians is paramount. Hospitals should develop selection criteria to determine cultural compatibility of possible physicians, vet their interviewing and hiring techniques to make sure they are competitive and include physicians in key decision-making discussions in order to recruit and retain the right physicians.
5. Reorganize primary care delivery models to manage care. Primary care delivery models need to be changed to help PCPs in their new roles as care managers, according to the white paper. Primary care physicians are moving to the hub of practice delivery models, they will not only be delivering care but also managing and coordinating care. Electronic health records can assist PCPs by facilitating information sharing and quality tracking. EHRs can also help streamline finances.
To help reorganize primary care delivery models, organizations can develop IT infrastructure and prepare for a patient-centered medical home system by putting a greater percentage of compensation at risk for demonstration of outcomes.
6. Select PCP-hospital alignment models and approaches. Hospitals should seek less formal alignment with primary care practices, along with having employed PCPs, according to the white paper. One way to achieve less formal alignment is by earning referral relationships through a physician liaison program.
Most organizations are in the early stages of achieving physician-hospital alignment, but systems like Kaiser Permanente and the Mayo Clinic are more advanced. An evolved PCP-hospital relationship links the practice to the healthcare organization with a commonality of mission, vision and values. Hospitals and health systems should consider multiple alignment approaches to meet the needs and interests of the PCPs and the organization, according to the white paper. They should identify goals for each alignment model and establish a process to achieve that alignment.
Health Strategies & Solutions, a Philadelphia-based national healthcare strategy firm, recently authored a white paper that gives six imperatives the healthcare executives must address as they plan and develop their primary care infrastructure.
1. Manage risk payments. Traditionally, compensation for primary care physicians was fixed or based on production. Now, as the responsibility for care management increases under reform, so does the portion of risk, according to the white paper. To prepare to manage risk in the short term, the white paper recommends hospitals partner with payors to assume more accountability for quality and outcomes, so PCP compensation increases. Also, hospitals can incorporate an integrated electronic health record to facilitate coordinated care and evidence-based clinical protocols for patient conditions with the highest utilization rates.
2. Achieve performance improvement and financial viability for employed PCPs. As budgets continue to become constrained and physician employment continues to rise, organizations need to learn how to employ physicians at lower subsidy levels and improve physician performance. In the short term, organizations can place a greater portion of PCP compensation at risk, to be earned by increased productivity and improved quality and cost control, and can identify and quantify high-return performance improvement initiatives.
3. Determine primary care network size, mix and geographic distribution. As the role of PCPs change, the correct number, mix and geographic distribution of PCPs changes for organizations. The need for primary care physicians is on the rise, with their increased role in care management and the aging of the general population, according to the white paper. Currently, the number of PCPs needed per 100,000 population is 60 to 80, but that is expected to increase by 20 percent in many markets. Therefore, hospitals need to determine what an adequately sized and geographically distributed network of PCPs would be for their area.
4. Implement primary care recruitment and retention strategies in highly competitive markets. With the increase in physician employment and the shortage of physicians, recruiting and keeping physicians will become more difficult and competitive, according to the white paper. Therefore, retention of physicians is paramount. Hospitals should develop selection criteria to determine cultural compatibility of possible physicians, vet their interviewing and hiring techniques to make sure they are competitive and include physicians in key decision-making discussions in order to recruit and retain the right physicians.
5. Reorganize primary care delivery models to manage care. Primary care delivery models need to be changed to help PCPs in their new roles as care managers, according to the white paper. Primary care physicians are moving to the hub of practice delivery models, they will not only be delivering care but also managing and coordinating care. Electronic health records can assist PCPs by facilitating information sharing and quality tracking. EHRs can also help streamline finances.
To help reorganize primary care delivery models, organizations can develop IT infrastructure and prepare for a patient-centered medical home system by putting a greater percentage of compensation at risk for demonstration of outcomes.
6. Select PCP-hospital alignment models and approaches. Hospitals should seek less formal alignment with primary care practices, along with having employed PCPs, according to the white paper. One way to achieve less formal alignment is by earning referral relationships through a physician liaison program.
Most organizations are in the early stages of achieving physician-hospital alignment, but systems like Kaiser Permanente and the Mayo Clinic are more advanced. An evolved PCP-hospital relationship links the practice to the healthcare organization with a commonality of mission, vision and values. Hospitals and health systems should consider multiple alignment approaches to meet the needs and interests of the PCPs and the organization, according to the white paper. They should identify goals for each alignment model and establish a process to achieve that alignment.
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