May 2010 | Reinventing Primary Care

Health Affairs founding editor John K. Iglehart writes about the Patient Protection and Affordable Care Act and the many changes ahead for health insurance, the health care delivery system, and patients.

Medical care and primary care were at one time synonymous. All health care was primary. The concept and terminology of primary care came into widespread use during the 1960s, reflecting a specific policy agenda: bolstering the role of the generalist ...

Despite contentious debate over the new national health care reform law, there is an emerging consensus that strengthening primary care will improve health outcomes and restrain the growth of health care spending. Policy discussions imply three ...

Medical practice redesign refers to the intentional efforts to improve practice processes and outcomes. Efforts to redesign office-based medical care go back some forty years. We divide the history of practice redesign into three overlapping phases: basic ...

The gap between the supply of primary care physicians and the demand for primary care continues to grow. Primary care practices must find a way to increase their patient capacity without sacrificing quality of care or adding more work to already ...

What would a Martian arriving on earth think about how U.S. primary care physicians spend their time? She or he would probably reach the same conclusions as this essay: that a new model for primary care should not be based on physicians’ seeing a high ...

A multi-stakeholder movement for primary care renewal and reform has emerged in the United States, out of recognition that the achievement of an efficient, effective, and sustainable health system requires a vibrant primary care sector. We describe the ...

In 2005, approximately 400,000 people provided primary medical care in the United States. About 300,000 were physicians, and another 100,000 were nurse practitioners and physician assistants. Yet primary care faces a growing crisis, in part because ...

The term primary care is widely used as if it were consistently defined or well understood. In fact, neither is the case. This paper offers a definition of primary care derived from historical ...

Population trends are driving an undeniable imperative: The United States must begin training its primary care physicians to provide higher-quality, more cost-effective care to older people with chronic conditions. Doing so will require aggressive ...

The U.S. health care system too often falls short in delivering effective primary care, especially for patients with chronic conditions. One potential solution is the patient-centered medical home, a model that has shown success in individual ...

Existing research suggests that models of enhanced primary care lead to health care systems with better performance. What the research does not show is whether such an approach is feasible or likely to be effective within the U.S. health care system. Many ...

As the patient-centered medical home model emerges as a key vehicle to improve the quality of health care and to control costs, the experience of Seattle-based Group Health Cooperative with its medical home pilot takes on added importance. This paper ...

Despite widespread interest in the medical home model, there has been a lack of careful assessment of alternative methods to pay practices that serve as medical homes. This paper examines four specific payment approaches: enhanced fee-for-service payments ...

Health reform legislation grants authority for patient-centered medical home pilot projects to test changes in the way primary care is provided. There is concern that using a measurement tool to qualify medical homes that is solely based on the presence ...

The patient-centered medical home concept is central to discussions about the reform of the health care delivery system. Most descriptions of the concept assume that a primary care practice would serve as the hub of the medical home. However, for people ...

We conducted a field study in three primary care practices representing different practice types: a solo practice; a certified patient-centered medical home; and a multiphysician, multispecialty practice connected to a local university. All three ...

In part because of their core generalist education, physician assistants can change clinical specialties over the course of their work life. This is known as career flexibility . Using medical care providers who can adapt ...

Although the physician assistant (PA) profession was created to bolster the primary care workforce, PAs have assumed increasing roles in subspecialties. This paper compares specialty prevalence between physicians and physician assistants, analyzes trends ...

Nurse practitioners are the principal group of advanced-practice nurses delivering primary care in the United States. We reviewed the current and projected nurse practitioner workforce, and we summarize the available evidence of their contributions to ...

Highly skilled primary care is a hallmark of high-performing health care systems. We examine nurse practitioners’ role in delivering primary care and the effects of current restrictions on their ability to practice. By resolving differences between states’...

Pharmacists can affect the delivery of primary care by addressing the challenges of medication therapy management. Most office visits involve medications for chronic conditions and require assessment of medication effectiveness, the cost of therapies, and ...

As the United States debates how to reorganize its health care system, policy makers must ask what patients really want and need from their primary care providers. There is often a disconnect between what patients say they want and what other providers or ...

Patients value the interpersonal aspects of their health care experiences. However, faced with multiple resource demands, primary care practices may question the value of collecting and acting upon survey data that measure patients’ experiences of care. ...

Performance-based payments are increasingly common in primary care. With persistent disparities in the quality of care that different populations receive, however, such payments may steer new resources away from the care of racial and ethnic minorities ...

Over their lifetimes, primary care physicians earn lower incomes—and accumulate considerably less wealth—than their specialist counterparts. This gap influences medical students, who are choosing careers in primary care in declining numbers. We estimated ...

Primary care is viewed both as the solution to better health care in the United States and as a threatened institution, beset by poor payment and difficult working conditions. Rhode Island has taken a direct approach to making primary care more effective ...

Policy makers and payers understand that physician payment reform will be central to driving improvements in the efficiency and quality of health care. We describe principles to inform physician payment reform developed by a multistakeholder group under ...

The concept of accountable care organizations (ACOs) has been set forth in recently enacted national health reform legislation as a strategy to address current shortcomings in the U.S. health care system. This paper focuses on implementation issues ...

The belief that integrated delivery systems offer better care at lower cost has contributed to growing interest in accountable care organizations. These provider-led delivery systems would accept responsibility for their primary care populations and would ...

There has been growing interest in the patient-centered medical home as a way to provide coordinated, high-quality primary care. At the same time, the number of retail clinics has increased dramatically. Many are concerned that retail clinics undermine ...

There has been much discussion in the policy arena about increasing the supply of primary care physicians or creating incentives to encourage physicians to practice in “medical homes” and focus on population health. However, innovations that deliver ...

Developing new models of primary care will demand a level of managerial expertise that few of today’s primary care physicians possess. Yet medical schools continue to focus on the basic sciences, to the exclusion of such managerial topics as running ...

Numerous reports predict U.S. primary care physician shortages, with deficits of 20,000–46,000 doctors projected by 2020–25. Doctors of osteopathic medicine (DOs) could help fill some of the gap alongside their medical doctor (MD) colleagues. Many ...

Primary care in the United Kingdom faced a crisis in 2000. General practitioners (GPs) complained of low morale, long hours, and low pay. The quality of care delivered to patients, meanwhile, was highly variable. The U.K. government responded with a ...

Canada is, in many respects, culturally and economically similar to the United States, and until relatively recently, the two countries had similar health systems. However, since passage of the Canada Health Act in the 1970s, that nation’s health ...

The financial burden of health care—the ratio of total out-of-pocket spending for health care services and premiums to total family income—continues to increase nationally. As a result of this trend, more people have been exposed to high costs and lack ...

A common assumption is that hospitals have little control over their costs and must charge high rates to private health insurers when Medicare rates are lower than hospital costs. We present evidence that contradicts that common assumption. Hospitals with ...

Taxes on sugar-sweetened beverages have been proposed to combat obesity. Using data on state sales taxes for soda and individual-level data on children, we examine whether small taxes are likely to change consumption and weight gain or whether larger tax ...

One of the largest drivers of the current obesity epidemic is thought to be excessive consumption of sugar-sweetened beverages. Some have proposed vending machine restrictions and taxing soft drinks to curb children’s consumption of soft drinks; to a ...

A physician yearns for patient-centered medicine as he watches his sister and severely ill brother-in-law search for a doctor who’s accessible and willing to coordinate care.

Overwhelmed by the demands of her medical practice, a dedicated primary care doctor makes the difficult decision to change jobs. Even more difficult is saying goodbye to her patients.