By EWA MATUSZEWSKI
The venture capitalist will see you now. Unfortunately, it’s not the lead-in to a joke. It’s the next inevitable step in usurping the role of primary care. As those of us long invested in the health-centered goals of the primary care community mark wins with the patient-centered medical home, team-based care and care management strategies; as we dive deeper into the role that social determinants of health play in limiting access to care and optimal health and wellness – and offer practical solutions; as we find success with data-driven, population health strategies…the business people see dollar signs, instead.
The impetus for this blog is the early February news that Humana entered into an arrangement with a private equity firm (okay maybe not venture capitalist – but outsiders, nonetheless) to create primary care clinics focused on the Medicare Advantage and dual-eligible population. Doing so will add to Humana’s existing senior primary care clinics, which have a multi-state footprint and were designed to lower healthcare costs while grabbing market share among the mighty senior population. It’s not just Humana, though, it’s a trend among large insurers and health systems. (I must add here that it irks me that the venture capitalists, private equity firms and other outliers are swooping in and tapping large insurers and employers, rather than seeking out partnerships with smaller practices who built the networks of primary care in this state – i.e., locally source healthcare.)
From urgent care clinics to variations of pharmacy Minute Clinics and the extension of authority of advanced care practitioners (highly valued, respected and necessary members of the health care continuum, but not physicians), there’s a mission creep in primary care that seems to be excluding primary care physicians, or at least moving them down the patient care ladder. But what can we do about this dismantling of PCMH practices and the primary care community that built them? How can the primary care physician, even and perhaps especially, the private practice primary care physician, regain their authority and the sacred role they play in the physician patient relationship?
As the saying goes, “No one gives you power. You take it.” But can you take it back? I’m not sure there’s a saying for that, but here are some steps that can be taken:
• PCPs need to band together in solidarity (their POs can help) against venture capitalists and other non-clinical opportunistic business dealmakers who aim to lure the coveted senor Medicare Advantage population through shiny new clinics. When patients believe their coordinated needs are being met, there is no incentive to leave a practice, regardless of age. A solidarity among primary care physicians can help stop a rush of seniors from seeking care elsewhere.
• Medical societies need to lay off the politics and turn their attention, and spending of annual dues money, back to physician members who seek guidance and advocacy for themselves and their patients on a holistic level. The trend is for medical societies to focus on a piece of the puzzle, such as pre-authorizations and administrative issues, often partisan in nature, that can be addressed by non-physicians. Medical societies instead, can re-focus some of their attention on preserving and strengthening PCMH-based primary care.
Circa 2007, I was a presenter at a state conference introducing the PCMH model. Several physicians walked out, complaining the fledgling movement would never gain traction and wasn’t worth their time. Well, they were obviously wrong; the PCMH model did take hold, thanks to its reinforcement of the value of the patient/physician relationship, solid foundational principles and the support of major insurers like Blue Cross Blue Shield of Michigan. But is it strong enough to hold up against all the outside money eager to invest in healthcare for profits, rather than patients?
If the greater primary care community doesn’t see what’s happening with the senior community (just for starters), they could be waiting in line behind their patients to see what the investors can offer them from what once was their very own primary care practice. Don’t kid yourself, a threat to primary care is a threat to the medical profession as a whole. #primarycarephysiciansolidarity