Primary Care is dead… no wait, it works!
In the US, fewer people than ever before have an established primary care relationship:
“Researchers found that in 2002, 77% of adult Americans had an established source of primary care, compared with 75% in 2015. This 2% difference translates to millions fewer Americans who now have primary care. Having primary care decreased over time for Americans in their 30s, 40s and 50s. Among Americans without complicated medical histories, having primary care declined over time in every decade of age through their 60s.” — 12/16/2019
To make the matter even worse, only 16% of the US population can be considered a “healthcare expert”.
Not only the average US person doesn’t have a stable primary care relationship, but she/he also doesn’t know how to navigate the system alone. On a non-eventful year, this is not a big deal, but this becomes tragic as unexpected health needs arise. While only 5% of patients account for 50% of the health needs/spend per year, this population has a significant churn year over year, which means that a broad preventive, primary care-based approach is the most impactful and cost-effective.
This type of approach is the single common thread between the top 30 countries in terms of health outcomes (spoiler alert, the USA is not one of them):
“Primary care is essentially provided by public providers, specialized family doctors and staff nurses, who provide preventive services to children, women and elderly patients, and acute and chronic care.” — 2/24/2019 Bloomberg
Most of these countries just spend about half of what the USA spends on healthcare as % of GDP.
Convenient and accessible preventive and primary care is also the approach that innovative and so far successful health care providers have taken, including Crossover Health, One Medical, Heal, Maven Clinic, Amazon Care, and Haven (the Amazon, Berkshire, Chase healthcare venture). These services focus on convenience, affordability, and quality, driven by the emerging consumer expectations of millennials generation.
Tech-enabled insurers such as Oscar, as well as the provider systems that partner directly with larger employers such as Walmart or Boing (more examples here), also use this playbook, and they are only at initial stages of developing such partnerships.
The difference from the Health Management Organization (HMO) experiment of the 90s, is the shift from a stick-based approach (you must get a referral from your PCP) to a carrot-based approach in which financial penalties for not going through your PCP are substituted by the convenience and benefit of accessing PCP services, in person and digitally, including behavioral, and reproductive, health, as well as services traditionally considered wellness like acupuncture and chiropractice.
I would argue that all these players are effectively trying to re-create an integrated, single-payer like, Kaiser-like system. I believe though that without a shared platform that performs the coordination that is embedded by design in such systems, fully brining back primary care to the Unitest States of America would be difficult.
So the question is, what it will take, and how long it will be, to make primary care cool again in the United States of America?
All views are my own.
