4 Tips for Your Primary Care Strategy

Primary care is evolving. Health systems have long recognized the need for control of primary care to feed their secondary and tertiary services. Population health and financial risk-sharing models have increased the urgency to tightly align primary care. Successful health systems will be those that recognize traditional primary care physician acquisition strategies are no longer sufficient and must be supplemented by other solutions.

Population growth, aging population and the coming insurance expansion will create a demand for as many as 52,000 additional primary care physicians by 2025.1 New physicians have little incentive to move into primary care where they regularly find longer hours and lower pay then their specialty counterparts. Recent studies have shown only 1 in 5 medical students choose primary care tracks, which, coupled with nearly half of the physicians in the United States being over 50 and preparing for retirement,3 increases the primary care need.


Further, the recent resurgence in health systems and hospitals using employment models for primary care has led to a 40 percent employment rate among physicians,4 which has led to the "locking up" of a large portion of primary care physicians in many markets. These factors will lead to an impossible situation for health systems seeking to fulfill their primary care needs through traditional methods of buying primary care practices, a method that basic economic principles tell us will become far more expensive and difficult as the physician employment pool dwindles. It has become essential for health systems to develop and deploy alternate primary care models.

Primary care must evolve strategically, and the following four steps are initial considerations for a primary care strategy.

1. Take a population-centered approach. Build the primary care physician base around proven models such as the patient centered medical home. These team-based approaches lead to healthier patients reducing repeat visits and allowing primary care physicians to improve access for more patients. This reduction in utilization and total cost of care is all important in a population–based reimbursement era.

2. Develop alternative models. Urgent care centers and retail clinics are projected to grow by 7 percent and 16 percent annually over the four years 2013-2017 and represent just over 16 percent of all primary care delivery up from nearly 12.5 percent today.5 These models are growing more rapidly than traditional primary care clinics because they offer care on the consumers' terms. Moreover, they are skewing towards privately insured and higher-income populations. Embracing urgent care and retail models can create primary care capacity for health systems.

3. Build virtual and online care. Virtual care for minor clinical conditions is being rapidly adopted by younger populations where available. Both synchronous and asynchronous models are being rapidly developed. With an average user age of 35, nearly 60 percent of one online treatment provider's patients do not have a primary care physician relationship, suggesting traditional primary care practices will likely never reach a portion of these patients. As a result, online delivery models provide channel for health systems to access new patients.

4. Use the available physicians strategically. Nurse practitioners and physician assistants are rapidly taking over aspects of primary care that has traditionally been provided by a physician. While many states still restrict the activities of non-physician providers, legislation is rapidly changing making non-physician providers an important strategy to leverage the physician time that is available. Developing a clinic model that uses physicians and non-physician providers to the highest extent of their credentialing can create as much as three times as much primary care access as a single physician.

Taking novel and strategic approaches to primary care development can make the difference in rapidly and sustainably expanding a health system's primary care footprint. When paired with primary care employment and private practice clinical integration, the four approaches discussed above create a winning solution for health systems moving into population health management.

Jeff Heidenreich is a strategic analyst and Luke C. Peterson is a principal at Health System Advisors. They can be contacted at Jeff.Heidenreich@HealthSystemAdvisors.com or Luke.Peterson@HealthSystemAdvisors.com. Health System Advisors is a strategy consultancy whose mission is to advise leaders, advance organizations and transform the healthcare industry.  

1 “Projecting US Primary Care Physician Workforce Needs:2010-2025”. Petterson et al. Annals of Family Medicine. 2012
2  “Where Have All the Primary Care Doctors Gone?” Chen.  New York Times.  December 2012
3“A Survey of America’s Physicians, Practice Patterns and Perspectives.” The Physicians Foundation. 2012
 Advisory Board survey quoted in the New York Times, “Same Doctor, Double the Cost”, 2012
4 “Health System Strategy: Remaining Relevant by Building Primary Care Beyond Physician Employment.” Heidenreich and Peterson.  Becker’s Hospital Review, 2013
5 “Trends in Retail Clinic Use Among the Commercially Insured” American Journal of Managed Care;  J. Scott Ashwood, MA, et al.; November 2011

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