Report: Practical and Scalable Solutions Can Overcome Worsening Shortage of Primary Care Access and Capacity, Improve Service Delivery

September 30, 2014
  • UnitedHealth Center for Health Reform & Modernization finds adding primary care physicians leads to fewer hospitalizations/ER visits; but supply limited in areas with lower incomes and higher rates of uninsured
  • In-market experience demonstrates nurse practitioners, team-based care and health information technology can better leverage existing primary care providers;
  • Innovative payment models that pay for value over volume are essential to achieving meaningful results

With 50 million Americans lacking adequate access to primary care – a shortfall set to worsen in coming years – UnitedHealth Group’s (NYSE: UNH) Center for Health Reform & Modernization issued a report today highlighting practical and scalable solutions that can increase primary care capacity and access to needed services, and improve care delivery. 

In the report “Advancing Primary Care Delivery: Practical, Proven and Scalable Approaches,” new research shows a clear relationship between more primary care physicians practicing in a local health care market and lower rates of avoidable hospital admissions and emergency department visits. However, even with an aging and sicker population and reductions in the uninsured, primary care office visits declined between 2012 and 2013.

The report also finds that the lowest concentration of primary care physicians occurs in areas with the lowest incomes and highest rates of uninsured, as well as in rural areas, indicating that focusing on physician supply alone may not address the largest gaps in primary care capacity.

The report examines existing best practices and key solutions that – if expanded at scale – can help close the primary care gap and improve care delivery, including:

  • Implementing innovative payment models that reward value. In recent years, reforms that recognize the value of the care a patient receives, rewarding physicians for their effectiveness and positive medical outcomes, have taken root. Government programs and private health plans should continue partnering with physicians, hospitals and other care providers to emphasize primary care in an effort to improve quality and reduce costs.
  • Expanding the roles of nurse practitioners and physician assistants. Primary care practices led by physicians can expand capacity by better leveraging a diverse clinician workforce. While laws governing scope of practice vary by state, there are opportunities to better utilize these skilled care providers to boost capacity and improve access to primary care. 
  • Assembling multidisciplinary care teams to deliver care more efficiently. It would take 17 hours per day for a primary care physician to provide all recommended care to a panel of 2,000 patients – and many have larger panels than that. In addition to nurse practitioners and physician assistants, care teams should expand the role of medical assistants and health coaches.
  • Using electronic health records and other health information technology (HIT) to share information across the delivery system in real time. Though HIT alone will not achieve dramatic improvements in primary care delivery, it is an essential building block, enabling practices to use resources as efficiently and effectively as possible. Electronic patient health records that travel through a single, user-friendly, interoperable system designed to share information systemwide are critical to achieving this goal.

Since 2009, the UnitedHealth Center for Health Reform & Modernization has released research and offered practical solutions to critical health care challenges, drawing upon United Health Group’s clinical and research expertise and data analytics capabilities.

“Primary care is essential to building a higher-performing health care system that promotes personal well-being and saves consumers and taxpayers money,” said Richard Migliori, M.D., executive vice president of Medical Affairs and Chief Medical Officer of UnitedHealth Group.  “This research shows the value of improving primary care capacity, not only in terms of improving patients’ health but also in catching problems early and avoiding unnecessary and costly hospital services.”

“The Center for Health Reform & Modernization has identified a broad range of practical, scalable solutions that can be tailored to local health care markets and policy environments,” said Cory Alexander, executive vice president of External Affairs at UnitedHealth Group. “These approaches, if embraced and adopted at scale, can meaningfully increase primary care capacity, improve quality and reduce health care costs.” 

The report identifies several examples of primary care providers that have boosted quality and reduced costs by partnering with private and government health plans in a “pay for value” model.

  • New evidence from UnitedHealthcare’s medical home programs in four states shows average third-year net savings of 6.2 percent of medical costs, resulting in a return on investment of 6 to 1, largely due to a payment model that rewards value.
  • By adopting a pay for value model, WESTMED in New York increased patient satisfaction, achieved an 8 percent reduction in emergency department use, and saw overall reduction in health care costs for privately insured patients.
  • Similarly, Monarch in California improved physician-patient communication, patient satisfaction, and prevention of hospital admissions that can be avoided with more timely care – while lowering costs for Medicare patients by more than 5 percent in just one year. 

“Through more effective use of existing resources and smarter incentives, we can bolster primary care capacity, increase access to the underserved and improve the effectiveness of care delivery across the health care system,” said Dr. Migliori. “WESTMED and Monarch represent successful models that can and should be scaled across the entire health care system, acknowledging the unique needs of each payer, provider, patient population and policy environment of each local market.” 

To read the full report, go to:

About UnitedHealth Center for Health Reform & Modernization
Drawing on our internal expertise and data and extensive external experiences and partnerships, the UnitedHealth Center for Health Reform & Modernization analyzes key health care issues and develops innovative policies and practical solutions for the health care challenges facing our nation.  We share this information in the U.S. and internationally with policy-makers, academicians, researchers, providers, health plans, employers, the public, and other key health care stakeholders.  In January 2009, UnitedHealth Group launched the UnitedHealth Center for Health Reform & Modernization to present proven strategies to contain costs and improve quality and care, and today, we continue to demonstrate our commitment to health care modernization by offering solutions based on proven policies and best practices.

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