Provisions of the Affordable Care Act (ACA) could lead to an additional 25 million primary care appointments every year.  The UnitedHealth Center for Health Reform & Modernization states in a recent report that, in order to lower costs and make primary care more accessible, providers need to phase out their fee-for-service models and incorporate multiple healthcare teams, diverse pay models and more technology.

As much as 50% of wasteful healthcare spending can be attributed to overtreatment and a failure to provide quality care and care coordination. The study also discovered that easy access to quality primary care services contributed to a decrease in emergency visits. According to the report, almost 70% of emergency visits by insured patients are for non-emergency problems.

In order to make primary care services more accessible for those in medically underserved communities, the report recommends implementing policies that increase the responsibilities of nurse practitioners (NPs) and physician assistants (PAs). The concentration of NPs and PAs is highest in the 10% of markets with the lowest concentration of primary care physicians.

For this to work, reimbursement models will have to be changed to include incentives for practices that use NPs and PAs. However, the current payment policy remains a significant barrier as Medicare and Medicaid generally reimburse less for services delivered by NPs and PAs than for the same services delivered by physicians.

Offering services that are tailored to the needs of the individual patient will also help practices transition to value-based payment models and increase patient satisfaction. The report suggests:

  • Retail or urgent care structured services that are offered after hours to decrease emergency department visits
  • House calls in order to determine the environmental factors affecting a patient’s health
  • Primary care physicians that focus on the 5% of the population who make up 50% of healthcare costs
  • Group visits with private exams and health education classes

Healthcare technology isn’t being used to its full potential. With the cost and time required for training and maintenance, and the lack of EHR interoperability, significant changes will have to be made in order to provide the best quality care for patients.

Author: Lauren Daniels

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