Primary care physicians – Solution or Chattel

How are PCPs perceived in the healthcare system? PCPs appear to be viewed as the necessary expense by hospitals and insurance companies. Specialists see PCPs as s referral source. RBRVS measurements are lower for PCPs than specialists. This creates the question on whether PCPs are the solution or chattel.
Managed care has stereotypically viewed PCPs as a Util. In the early 1990s managed care created gatekeeper based insurance products with the expectation that PCPs will practice population healthcare for a few dollars a month. This failed. PCPs lost money spending the extra administrative time on their patients. PCPs responded by writing referrals and scripts for care as requested by the patient…undermining the premise of the gatekeeper program
Patient Protection Affordable Care Act (PPACA) has once again recognized the value of the PCP in the management of care. Once again there is little compensation for the additional administrative work. The difference between the 1990’s and now is that PPCAA is holding the health plans and Accountable Care Organizations accountable for the PCPs practicing population healthcare. HEDIS-33, STAR Ratings plus capping the gross margins of health plans at 15% are the tools utilized by Health and Human Services to force insurers into the active management of their members care
The challenge for the health plans will be how to impact Population Healthcare for their members. Success in the post PPACA Healthcare field will require the integration of PCP practice patterns with Population Healthcare principles. The first step will be a fundamental change in mindset towards PCPs as a key part of the solution, not as chattel.

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