Primary care crucial to team-based models, triple aim initiatives

Physician assistants (PAs) may be at the best advantage to adapt to new care delivery models, according to Lawrence Herman, president of the American Academy of Physician Assistants, one of several healthcare experts who spoke Tuesday on workforce trends at the American Hospital Association's (AHA) annual membership meeting in the District of Columbia.

Approximately 80 percent of PAs practice acute care medicine and about two-thirds manage chronic care patients, according to Herman (pictured right). PAs are at an advantage because of four "mega-trends" in medicine, he said, including:

  • The shift from volume-based to value-based care.

  • Increased adoption of technology. Many PAs were "raised by digital screens, so they are the champions when it comes to things like… empowering patients using technology."

  • The "shift to a consumer-centric market."

  • A renewed focus on preventive medicine.

Robert L. Wergin, M.D. (pictured left), president of the American Academy of Family Physicians (AAFP), said that primary care is key to any "triple aim" initiative to improve care, improve health and reduce costs.  "There is no credible healthcare delivery system in the world that can deliver on the triple aim… that isn't founded on primary care," said Wergin.

Team-based care, Wergin said, is the ideal solution to the complications from increased patient volumes. He emphasized the need to permanently repeal the sustainable growth rate, and beyond that, "we need payment reform to help support the infrastructure to move to team-based care in our country, and to do that, we need a payment model that truly values primary care."

"The first time [clinicians do interdisciplinary work] should not be at the patient bedside with a critically ill patient or a complex issue," added Herman. "This should be ingrained in our training from the get-go."

Panelists also discussed what could be done for healthcare at the academic level. "One of the areas we consider to be concerned about is diversity. We focus very strongly on that," Herman said. "Our program is 19 percent more diverse than other PA programs, but that's not saying a lot to be honest."

"My generation--baby boomers--are all beginning to retire from academia," said Kenneth P. Miller, co-president of the American Association of Nurse Practitioners. "If you don't have the faculty to be able to teach these students, you're going to have to cut back on your numbers."

To learn more:
- read the AAFP's workforce reform recommendations