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Everyone wins when physicians put patients first


It certainly doesn’t sound like a radical notion, but the idea of putting patients first is creating something of a revolution in healthcare that is lowering costs while delivering high-quality care to millions of Americans.

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, who is also past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


Glen Stream, MD, FAAFP, MBIIt certainly doesn’t sound like a radical notion, but the idea of putting patients first is creating something of a revolution in healthcare that is lowering costs while delivering high-quality care to millions of Americans.


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Leading the revolution are primary care physicians under a model that makes them responsible for creating and heading a “medical home” for patients-a place where they can seek treatment from primary care physicians and other professionals, and coordinate any needed care with sub-specialists and hospitals. The idea is to enhance preventive care, improve disease management and patient outcomes while cutting the system’s inefficiencies.

The approach is already paying dividends.

In Oregon, a groundbreaking study released in October found that the state’s Patient-Centered Primary Care Home (PCPCH) program saved its healthcare system an estimated $240 million between 2012 and 2014 and predicted that the growth of the program would lead to even greater savings in the future.  

By putting the focus on primary care, state health officials say, Oregon is making huge strides toward improving the health of its citizens while at the same time lowering costs. According to the study commissioned by the Oregon Health Authority, for every $1 increase in primary care expenditures under the PCPCH model, the state’s healthcare system realizes an average savings of $13.


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Another popular model that’s putting patients first is the Accountable Care Organization (ACO)-a group of doctors, hospitals and other healthcare providers who voluntarily work together to give high-quality care to their Medicare patients. While different in a number of respects, Medicare ACOs share the same goals as the PCPCH model-improving healthcare services and the quality of care for patients while keeping costs down.

Next: Trump needs to take a look at what is working well


They also represent a new approach to delivering care, one that the Centers for Medicare & Medicaid Services (CMS) says moves away from a system that “rewards the quantity of services to one that rewards the quality of health outcomes.”

It’s also paying off. According to CMS, ACOs in 2015 continued to improve the quality of care for Medicare beneficiaries while generating hundreds of millions of dollars in savings. A report by CMS found that over 400 ACOs produced more than $466 million in savings for Medicare in 2015 alone. And by lowering costs and meeting certain quality performance standards, 125 of them qualified for “shared savings” payments under a provision of the Affordable Care Act. 


Further reading: Where is the future of primary care headed?


While President Donald Trump and Republicans in Congress have vowed to repeal and replace the ACA, they should take a close look at what’s working well under the current law and keep it. Regardless of political persuasion, Republicans and Democrats alike should be able to find common ground on initiatives that ensure quality care for all Americans while saving money for government programs like Medicare and Medicaid as well as the broader healthcare system.

An important component is the Affordable Care Act’s emphasis on strengthening primary care. But while primary care should serve as the foundation of a strong healthcare system, that’s increasingly a problem in the United States where there is a glaring and widening imbalance between the number of primary and sub-specialty care professionals.


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Today in the U.S., sub-specialists outnumber primary care physicians two to one. Sixty-five million Americans live in what some have called “a primary-care desert.” And by 2025, the Association of American Medical Colleges says the country could face a shortfall of as many as 31,000 primary care physicians.

In formulating new policy, Congress and the Trump Administration must recognize the essential role of primary care in building an efficient healthcare system. They should also understand that any attempt at health care reform that fails to strengthen the nation’s primary care base is inevitably doomed to fail.


Glen R. Stream, MD, MBI, is a family physician in La Quinta, California, and president of Family Medicine for America’s Health, which sponsors Health is Primary.



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