PwC Report: Most Primary Care Teams Are Not Designed to Optimize Care

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Most primary care teams are not designed to optimize care or meet consumer demands for convenience and value, according to the latest report from PwC’s Health Research Institute (HRI). The PwC report reveals that a primary care dream team designed around the needs of complex chronic consumers, for example, could potentially result in $1.2 million in savings for every 10,000 patients served. Designed with consumer needs and preferences in mind, the primary care dream team can bring together wellness, prevention and healthcare to address the whole person.

The key report findings are based on a a survey conducted in 2015 of 1,500 American primary care physicians, specialists, nurse practitioners, physician assistants and pharmacists as well as a survey of 1,750 American consumers conducted in the summer of 2016.

As the primary care model shifts from a primary physician led healthcare to a broader care team incorporating non-physicians (e.g. dietitians, mental health professionals, clinical educators, social workers, etc.), HRI finds that: 

The role of the non-physician: To be cost-effective, a primary care dream team that takes into account consumer preferences and their complex health needs should be heavy on non-physicians; This team should have three parts – a core team, an extended care team and a community connector team.

Market-dependent healthcare: Different consumer markets will require different team rosters based on their whole health needs. For example, a frail elderly consumer, would likely interact most often with care navigators, geriatricians and community paramedics, but rarely with nurse practitioners, nurses and medical assistants.

Nurse practitioners take center stage: 75% of consumers surveyed by HRI this year said they would be comfortable seeing a nurse practitioner or physician assistant instead of a physician for certain services.

Team approach = Health Goals: Those who did see a broader spectrum of professionals thought they were at least moderately effective at helping them achieve their health goal.

Today’s primary care doctors are not being deployed effectively. HRI’s 2015 clinician survey found that they spend more than one third of their time on administrative work, discussing behavioral health issues with patients, and addressing patients’ social barriers to care such as poor transportation, lack of child care and food insecurity.

Clinicians surveyed by HRI said that they expect that primary care doctors will play elevated roles over the next 10 years. Sixty-four percent of clinicians believe primary care doctors will spend more time triaging consumers to other caregivers, according to HRI’s survey. Seventy percent say they will spend more time as consultants to teams caring for consumers, and half believe they will spend less time providing in-person care.

4 Steps to Succeed in the New Model for Primary Care

To succeed in this new model for primary care, HRI recommends healthcare organizations should take the following steps:

1. Understand consumers: Organizations should segment their populations into the seven consumer markets and design primary care dream teams around them. Healthcare organizations should focus as much on improving the factors around the caregiver-patient interaction as on the interaction itself

2. Understand the impact and consequence: Healthcare organizations should create business cases for primary care by understanding how such a dream team strategy could impact their business model. Optimizing primary care will likely create excess capacity in hospitals, such as in emergency departments.

3. Market dynamics should be part of the calculation. Healthcare organizations should ask what returns they need from the primary care dream team and what combination of volume and upside risk will allow them to achieve it. In markets that are dominated by payers pressuring providers to achieve lower costs of care,
providers will be better positioned to adopt the new primary care model because the network management infrastructure already exists. In markets that are dominated by healthcare providers, providers should pursue risk-based arrangements with payers or potentially build their own health plans.

4. Use data and analytics to design, deploy and deliver: Healthcare organizations should deploy technology to stratify consumers and discover where cost-saving opportunities lie. They should determine the mix of services and staffing approaches to optimize care, and then deliver care efficiently.

For more information on the report, visit https://www.pwc.com/us/en/health-industries/health-research-institute.html