Non-physician providers play critical role in optimizing care

There’s a shift happening from primary physician-led healthcare to a broader care team incorporating non-physicians, according to a new report.

PwC’s Health Research Institute (HRI) report found that most primary care teams are not designed to optimize care-or meet consumer demands for convenience and value. Consumers, and clinicians, are ready to embrace broader care teams composed of physicians, non-physician clinicians, and care connectors, e.g., social workers, clinical educators, care managers.

Stock

“Healthcare organizations should assess how a reconfigured primary care model, as outlined in this report, can impact ROI and allow for reinvested savings in other lines of service,” says Harlan Stock, Manager, Healthcare Advisory at PwC.

Specifically, HRI found that a primary care team designed around the needs of complex chronic consumers could potentially save $1.2 million for every 10,000 patients served.

“Today’s healthcare demand models often overstate demand for primary care physicians,” according to Stock.

The Association of American Medical Colleges estimates the U.S. needs nine primary care physicians for every 10,000 persons.

“Advanced primary care models, however, such as those based on patient-centered medical homes, estimate the need at much less-our report refers to one estimate of six primary care physicians,” Stock says. “The takeaway is that demand is hard to estimate and staffing models are more complex than those used to generate traditional demand estimates.”

Based on PwC’s clinician surveys, primary care physicians are spending too much time on administrative work-up to one-third-and not enough time practicing at the top of their license.

In addition, traditional fee-for-service models emphasize care volume over care quality.

“As a result, most primary care teams are not designed around care management and prevention,” Stock says. “Primary care physicians are aware of the changing dynamics and consumer trends. According to our surveys, they do see value in harnessing the skill sets of a diverse care team-nutritionists, mental health professionals, social workers, and physical therapists all included.”

Primary care physicians see the value in a broader care team, according to Stock. “But there is often mismatch between the ideal and what is currently in place. A diversified care team allows primary care physicians to focus on the most critical of patients [e.g., those with complex chronic diseases]. The benefits are not just in terms of overall patient care-there are real-world savings at stake, savings which could then be reinvested based on the specific needs of the organization.”

Segmenting the primary care consumer group (seven of them)-frail elderly, complex chronic disease, chronic disease, mental health, health families, healthy adult enthusiasts, and healthy adult skeptics-allows the organization to operate more efficiently and cost effectively, according to Stock.

“This approach also aligns with value-based reimbursement,” he says.

Based on the report, Stock has four recommendations for managed care executives.

1. Consider the seven consumer groups and how our approach to primary care can be adjusted to their unique needs.

2. A number of notable healthcare organizations have already found ways to make investing in primary care teams pay off.

3. Know your consumer market. “This will help define how best to configure and ultimately deploy your primary care dream team,” Stock says.

4. Consider how this primary care model will impact the overall organization, and may require you to plan for excess capacity vis-à-vis reduced inpatient days, etc.