Primary Care: A Symphony or a Cacophony?

Your simple act of walking into a primary care office sets off a series of events orchestrated by unseen conductors. Is this a good thing?

The process used to be simple; your primary care physician owned her own practice, and referred you to other clinical sites when she thought it best for your care. This might be one of the local hospital clinics, or an academic center for specialist care. Formularies have always been, and probably always will be, a restriction on drug prescribing. But for both referral patterns and prescribing autonomy, primary care decisions are being influenced by new conductors acting behind the scenes. Here are several examples:

1. The academic center has purchased your primary care physician’s practice. You can’t tell, since even the shingle hanging by the front door hasn’t changed. But now, the conductor at the academic center insists you are referred to the academic hospital for any level of care. The local community hospital may not be an option any more
2. Your insurance company now owns many local sites providing primary care services. CVS Health Hubs and Minute Clinics are an example. This means if you (or your employer) bought a healthcare policy from Aetna (owned by CVS), the conductors at Aetna may insist that you visit a Minute Clinic first, not your favorite physician in her practice
3. Today, private equity firms are buying more primary care practices than hospitals are. In this case the conductors are savvy businesspeople who will look to cut expenses and maximize revenue
4. A new conductor in this space are companies like Morgan Health. Morgan provides primary care services on or near the office space of their employer customers. The employers pay Morgan a per-member-per-month fee to reduce healthcare costs. If you were to visit the clinic at your place of work, Morgan Health would be the conductor ensuring your healthcare costs are minimized for your employer. When all healthcare costs are added up for the year, Morgan Health would share in the savings they orchestrated by directing your care

These scenarios are not necessarily bad. They are simply different solutions to the rising cost of healthcare. If your health can be maintained at the lowest levels of service, that is a benefit to all stakeholders, including you. But do you know who is truly orchestrating your care? The conductor is not always the physician standing in front of you.

Want to learn more about the latest ways healthcare stakeholders are trying to gain control over primary care decisions? Enroll in The Current and Future State of Healthcare MAP Training Program today!