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    We need to continue progress in primary care

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, who is also past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    This year, Washington, D.C., was once again the epicenter of the debate about the future of healthcare in America. However, often unrecognized amid all the noise are a number of remarkable advancements made across the country that strengthened and advanced primary care.Dr. Stream

    From state-level innovations to ground-breaking research, primary care systems continued to deliver on the Triple Aim of providing better quality healthcare that improves population health while lowering costs. Since we’ve wrapped up 2017, I wanted to share what I believe were the top five achievements made in primary care last year:

    1.    States Increased Investment in Primary Care

    States are important innovators in primary care and this year they have been at the forefront of investing in innovative systems that place patients at the center of care. For example, new legislation in Oregon requires all commercial insurers in the state to invest at least 12 percent of their total medical expenditures into primary care by the year 2023. Proponents of the law pointed to the success of the (PCPCH) program to bring the bill over the finish line. The PCPCH program has been in place for several years and has saved Oregon millions of dollars—roughly $13 in savings for every $1 increase in primary care spending.

    California is working with 11 health plans to promote and enhance primary care for the 1.4 million individuals currently enrolled in the state’s official health insurance exchange, . This year, Covered California began requiring all enrollees to be matched with a primary care clinician to serve as a “patient advocate” and first point of contact to the healthcare system.


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    Other states including Rhode Island and Michigan are also championing initiatives to transform primary care practice and delivery.

    2.    Home-Based Primary Care Saved Millions for Medicare

    This year, the CMS Innovation Center released initial findings of its , a program that provides chronically ill patients with access to primary care services within the comfort of their own home. “allows health care providers to spend more time with their patients, perform assessments in a patient’s home environment, and assume greater accountability for all aspects of the patient’s care.” As of January 2017, the initiative saved participating practices over $7 million, an average of $746 in savings per Medicare beneficiary. The initial results of this program reiterate the value of home-based primary care and its ability to improve the overall quality of care and life for patients served while reducing costs.

    Next: Primary care should be at the heart of our healthcare system

    Glen Stream, MD, FAAFP, MBI
    Dr. Glen Stream, a family physician practicing in La Quinta, California, is past president of the American Academy of Family Physicians. ...


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    • [email protected]
      Unbelievable. Programs where the cost of compliance far outweighs any increased payments (locus classicus - PCMH which has been PROVEN to cost 80-100 K per physician per year) is regress, not progress. The damage this kind of thinking has done to our specialty is incalculable. Please, just stop.
    • UBM User
      You’re delusional!! If there is to be any progress in primary care, Medicare needs to pay us more! I’ve been in private practice for 30 years and anytime Medicare wants to pay us more, we have to jump through more hoops for them and submit info that we’re jumping! Physicians like you are the problem. You’re deceived into thanking primary care is getting better. It’s worse!! Why do we have a significant primary care shortage? Why is the role of NP’s increasingly? Because things are worse for primary care! States aren’t investing in primary care!! Primary care incomes are not significantly increasing because of states investment. If that were the case there wouldn’t be a primary care shortage that’s only getting worse! You need to wake up. Like I said you’re delusional. You part of the problem not the solution.
    • [email protected]
      All of this is undoubtedly wonderful news, but one model of primary care is glaringly omitted. Direct Primary Care, a model that in it's purest form does not involve insurance, is making significant contributions to the improvement of primary care delivery via longer appointment times, unlimited visits including email, text and video as well as reduction in healthcare spend via no copays or deductibles and the availability of ancillary services and medications at significantly reduced cost. Although a relatively small percentage of primary care practices are currently DPC, the number is growing. Besides the benefits to the patient, there are also significant benefits to the physician such as fewer patients/day, no intermediary for payment or other intrusive regulations as in insurance-based practices thereby allowing the physician to practice medicine the way they see fit, not as how a third party tells them to. All in all, a wonderful alternative to traditional primary care.

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