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Primary care is the foundation of US healthcare. It’s reported that primary care is the “only” area in which providing more services—such as childhood vaccines and regular blood pressure screenings—is linked to better population health and more equitable outcomes. Yet, primary care is struggling. Several drivers are making it harder for physicians to do their best caregiving and patients to receive the timely access they need. Components of an effective care management program are essential to reimagining primary care in the next five years. A number of factors are pushing primary care to change profoundly in the next five years. These are driving Congress, regulatory bodies, professional associations, payors, and providers to rethink the country’s approach to general medical care. Two keystone causes stand out. Depending on the source, the primary care physician shortage could be 45,000 by 2030 or 68,000 by 2036. However, primary care across the US is already experiencing the effect of insufficient primary care physicians, particularly in rural areas. According to the Primary Care Collaborative, every state has seen a reduction in primary care doctors per capita. Figure 1. Ratios of primary care physicians per 100,000 population by US state in 2021. Source. Primary care doctors retiring or leaving the field outnumber new medical school graduates choosing family medicine or internal medicine specialties. Figure 1 shows the ratio of primary care physicians per 100,000 people in 2021. TheNational Resident Matching Program shows that 89% of 5,088 family medicine residency slots were filled in 2023, compared to an overall 93% residency fill rate across all specialties. While internal medicine sees 96% of residencies filled, a significant proportion of those residents eventually choose a specialty area other than primary care.What’s driving primary care’s transformation?
Primary care physician shortages
One primary reason for this gap is the pay discrepancy between primary care and other specialties; however, other issues affect a student’s choice and a physician’s desire to stay in primary care.
Doctors cite high overhead costs, expanding administrative workloads, and patient quotas as reasons they leave individual practice, go part-time, or take non-clinical roles.
Plus, today’s generation of physicians want more work-life balance, as many are overwhelmed and burnt out.
Increased demands on primary care
Primary care has experienced an increase in responsibilities due to several shifts:
- More care is directed to ambulatory, home, and virtual settings
- Demands for physical-mental health integration
- Focus on care transitions and avoiding readmissions
- Physicians are becoming more specialized
- Trickle-down effect causes generalists to provide more care services
- Goals to address social determinants of health and equity
- An aging population with more chronic illnesses
Government agencies, such as the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, are allocating more money to primary care doctors. They’re also training more health workers and launching new primary care innovation programs. But fundamental shifts must be made in the face of growing pressures.
Is care management the future of primary care?
Care management has been around in one form or another for decades. However, when coupled with technology-enabled platforms and telemedicine, the current iteration offers a model that could become the basis for most primary care.
Care management-oriented models can create a foundation for primary care redesign. They can enable physicians to improve quality, access, and patient satisfaction.
Studies link care management to improvements in clinical quality. Its approach leverages key components, standards, and models that deliver efficient and cost-effective care.
This is particularly crucial in a future where 20% of Americans will be 65 or older by 2025, and 40% of adults live with two or more chronic conditions.
Care management can transform primary care
When combined, the following three aspects of care management create synergies foundational to reimagining primary care.
Team-based care
According to the authors of a study of 12 academically affiliated primary care practices participating in a learning collaborative, “team-based care is considered central to achieving value in primary care.”
Research cited in Family Practice Management pointed to a care delivery model that “when done well, can greatly reduce physicians' administrative burden and elevate clinical staff's role while improving patient experience, quality, and safety.”
Most physicians are probably aware of basic team-based care models; however, advanced team-based care is a comprehensive, integrated model. In it, physicians perform strictly those functions they are uniquely trained and qualified to carry out.
Care management is based on this approach, which involves building a team of key professionals who can individually work at the top of their licenses.
A study of 12 million primary care visits between 2013 and 2018 found that team-based care management was superior to solo practitioner-based care management, regardless of practitioner type.
The research focused on care management and biomarker outcomes after the onset of three chronic diseases – type 2 diabetes mellitus, hyperlipidemia, and high blood pressure.
The Agency for Healthcare Research and Quality shared research on primary care transformation, which found that care coordination and team-based care were vital to successful transformation.
Care coordinators were recognized as integral to a “practice’s ability to provide proactive care, support families, and reach out to communities,” along with other benefits, including:
- Many physicians reported they would not go back to their previous care model without care coordinators
- Greater care manager involvement and integration with the team achieved the most improvement in diabetes outcomes
- Team-based care improved patient and provider satisfaction
- Training clinical team members other than nurses and physicians to work with patients on self-management increased patient engagement
Central to this study was the finding that using other care team members in expanded roles helped physician efficiency. This made office visits more productive and gave physicians more time with patients.
Physician-led teams
Embracing an advanced team-based model for primary care necessitates physicians evolving their role toward team leaders.
A journal article in the Annals of Family Medicine outlined several mindset shifts (Figure 2) that physicians and care team members should make to “energize primary care.”
Figure 2. Shifts in mindset that support widespread adoption of advanced team-based, physician-led care. Source.
According to the American Medical Association, “Physician participation, if not leadership, in the multidisciplinary team effort remains essential to effectively delivering the full spectrum of high-performance primary care demanded by society.”
Physicians have seen their responsibilities expanded to the degree that modern primary care needs “an evolution from the revered solo-physician model to a multidisciplinary team-based effort.”
When physicians are the clear leaders of a care team, as seen in patient-centered medical homes, satisfaction surveys show results. Physicians tend to be more satisfied with the quality of care in their interactions with patients and experience less burnout.
Team-basedprograms can empower physicians to maximize their expertise and act as mentors and educators.
Advanced practice providers
Expanding the participation of advanced practice providers (APPs) on the primary care team is critical. APPs can help meet needs for basic medical care, as well as address chronic conditions in aging populations.
Even before the pandemic, more than 25% of Americans saw the main two types of APPs, aka “mid-level providers,” such as nurse practitioners and physician assistants. That percentage doubled between 2013 and 2019 as physician shortages were felt more acutely.
Some research says that the percentage is now closer to 82%.
The research report, “Primary Care 2030: Innovative Models Transform the Landscape” estimates that "over the next decade, nontraditional primary care providers could capture around 30% of the US market.”
Figure 3. Who are the professionals providing primary care? Source.
Today, most care is delivered through physician-centric teams where:
- 70%+ of physicians don’t work alongside other specialists
- 45%+ don’t work alongside advanced practice providers
In a team-based, physician-led, care management-oriented team, APPs will likely continue to focus on routine and urgent care while physicians handle the most complex cases.
Evidence shows that APPs are an asset to a primary care team, particularly for chronic disease management, women’s healthcare, and preventive care.Numerous studies have also shown that mid-level practitioners can provide care quality on par with physicians when appropriate.
In light of continued and increasing physician shortages in primary care, authorizing full practice authority for nurse practitioners nationwide, for example, would expand access to primary care for nearly 31 million people.
Expanding the team, maximizing APPs, and adding care management services can lead to serving more patients and growing revenues.
ThoroughCare helps transform primary care
ThoroughCare is an end-to-end care management solution that provides everything providers and their care teams need to transform care delivery.
ThoroughCare enables team-based, physician-led care management. Our platform supports:
- Full workflow for enrollment, care planning, screenings, and assessments
- Educational resources to help patients understand their conditions
- Two-way secure text messaging to enable communication and access
- Care coordination between primary care physicians, clinicians, and specialists
- Automated documentation and CPT code assignment
