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Hospitals to lead primary care delivery overhaul

AHA: Workforce shortages, ACA necessitate primary care redesign
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"Hospitals can serve as conveners and enablers in primary care delivery," the American Hospital Association (AHA) said in a report, released yesterday.

The report showcases results from a September 2011 AHA Primary Care Workforce Roundtable, in which physician and nurse leaders discussed the impact of the Affordable Care Act on the workforce and primary care.

The group found that hospitals not only play a key role in transforming primary care but also are the "catalysts" to providing a sustainable infrastructure of care delivery. Therefore, hospital senior managers, especially the CEO, should be involved in value-driven redesign, AHA said.

An additional 32 million insured Americans are estimated to come into the system under health reform. Amid physician and nursing shortages, the United States is expected to fall short of nearly 30,000 PCPs by 2015, although a study in this month's Health Affairs finds those numbers may be exaggerated due to outdated patient-provider ratios.

Nevertheless, the AHA group found that workforce limitations don't necessarily have to stall primary care innovation. In fact, in rural areas where the workforce shortage is particularly acute, necessity is the mother of invention.

For instance, at Wisconsin's ThedaCare health system, rural health coordinators (with nursing clinical backgrounds) on the Community Health Action Team (CHAT) visited 325 farmers in the past eight years. They provided screenings, offered health information and connected families with health and social services. Through the program, they identified 200 people in need of acute care for chronic conditions.

"Hospitals should evolve from traditional 'hospitals' to 'health systems,' partnering with community organizations and patients in order to advance the community's wellness and health needs," the report noted.

Among best practices for accountability-based primary care, AHA recommended the following:

  • Use culturally aware care coordinators to manage patient needs
  • Clearly delineate roles for each team member but leave room for modification for population needs
  • Collect primary care data on the whole team and not the practitioner
  • Think of role-based, not task-based, care delivery
  • Function in a team-based model with inter-disciplinary clinical learning teams

For more information:
- see the AHA report (.pdf)

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