4 ways to improve primary care delivery

Several practical solutions could offset the primary care shortage, according to a new report from the UnitedHealth Center for Health Reform & Modernization.

As more primary care physicians (PCPs) practice at a local level, avoidable readmissions and emergency department (ED) use declines, according to the report, "Advancing Primary Care Delivery: Practical, Proven and Scalable Approaches." Despite this correlation, the aging population and a steep decline in the number of insured, PCP office visits fell between 2012 and 2013, according to the report.

Increasing the number of PCPs may not solve the problem, the report states, as PCPs are in shortest supply in low-income, low-insured areas, many of which are rural communities. Several solutions and existing best practices could address these issues, however:

Value-based payment models: Payment systems that provide incentives for value and outcomes over intensity of service "are fundamental to increasing primary care capacity and improving the effectiveness and efficiency of service delivery," the report states. This could include performance-based bonuses linked to quality benchmarks or risk-adjusted monthly payments for primary care.

Expanded responsibilities for nurse practitioners (NPs) and physician assistants (PAs): Leveraging non-physician clinicians can help practices expand capacity, according to the report. This is demonstrated by expanded scope of practice for NPs and PAs in several states, including New York and Kentucky.

Multidisciplinary care teams: To further distribute their workload, PCPs must also expand responsibilities for professionals such as health coaches and medical assistants. Such multidisciplinary efforts historically improve outcomes and cut costs, according to the report.

Healthcare information technology (HIT) such as electronic health records: Use of HIT helps PCPs distribute and collect nformation in real time, which means better coordinated care and increased quality, according to the report. "[B]roader implementation of HIT can increase systemwide capacity to meet increased demand, improving access to primary care," the report states.

To learn more:
- read the report (.pdf)

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