The passage of the Affordable Care Act expanded healthcare to millions of Americans — in fact, 59% of primary care physicians report that expanded access to insurance has resulted in their seeing more patients. Furthermore, these physicians with booming patient rosters say that their provision of high-quality medical care is unchanged or better than ever. It seems higher volumes have maintained or even improved care standards.
However, 62 million people in the United States have no or inadequate access to primary care. It’s important to remove barriers to care for these patients, so that they don’t miss out on prevention and early-intervention care, and critical diagnosis and ongoing care of chronic conditions — all of which are key drivers of performance efficiency in the current healthcare marketplace. Forty-three percent of no-/low-access patients are low-income, 28% live in rural areas, and 38% are racial/ethnic minorities. About 80% of patients lacking primary care access have insurance, so it’s a matter of removing barriers to care on the provider side. Here are three strategies for extending primary care access.
1. Target services
Improving healthcare services depends in part on ensuring that people have a usual and ongoing source of care — which, in turn, helps patients have better health outcomes. But, first, patients have to be able to find a primary care service. Help them come to you by performing outreach to the populations most likely to be underserved, and make it convenient for them to contact your practice. For example, create a practice website with online appointment booking and a working mobile browser version (68% of adults in the U.S. have smartphones). This way, patients can reserve in advance the time and day they can attend. Follow up with emails and text reminders. If they can’t come to you, go to them. Offer general appointments and ongoing monitoring via telemedicine, which has “proved particularly beneficial in monitoring patients with hypertension, congestive heart failure, diabetes, wound care, and chronic obstructive pulmonary disease,” as well as to increase patient satisfaction and reduce hospital (re)admissions, according to a recent report.
2. Supplement workforce
There is a shortage of primary care physicians, and it’s only going to get worse. The Association of American Medical Colleges projects that the US will face a primary care shortfall of between 46,000 and 90,000 physicians by 2025. Those numbers are outside the control of individual practices, but you can make the most of the human resources you do have. Supplement the physician team with physician assistants, who can diagnose illnesses, write prescriptions and counsel patients on preventive care; in some states, advanced practice nurses can also provide these services under the supervision of a physician. In addition, practice nurses can be tasked with placing “risk-ranked adherence calls, [with] call scripting focused on identified risk areas” to help patients with chronic conditions in managing their ongoing care. Patients should have a designated nurse, to help them develop a personal relationship with their primary care service. Use medical scribes to keep up with the greater number of patients being cared for. With scribes seamlessly creating thorough documentation in real time, the administrative burden on primary care physicians will be significantly eased, letting them focus on patient care. In addition, the comprehensive documentation that results will help the practice meet the requirements for earning the Medicaid chronic care management reimbursement each month, as well as create a base for any specialist services that may be needed.
3. Opening up documentation
For patients eligible for the Medicaid chronic care management program, the comprehensive care plan must be shared electronically with other treating physicians. Even for those who are not, the documentation compiled over regular primary care visits is vital to ensure that patients receive appropriate care from specialist services. Thorough documentation begins with using medical scribes, who transcribe each patient encounter as it happens, so that the physician can maximize the information elicited from patients during limited visit time. In addition, the push to expand patient access to their medical records is picking up steam, for a number of reasons. Opening up documentation may be most important for patients with restricted access to primary care, so that they can become more involved in their own health management and reach out to healthcare services as needed.
Having a positive impact
Improving access to primary care has been shown to improve health outcomes more effectively than simply having insurance. Health problems are prevented or diagnosed early, saving the system money on high-cost and acute interventions. In addition, patient quality of life, even with chronic conditions, is improved, and fewer patients die early. Primary care providers must lead the charge to remove barriers to access and utilization of services.
