Primary Care

The entry point into the health system for most individuals, through a provider that delivers non-specialized, continuous, and coordinated care.

Restricted Provider Choice in the ACA Marketplace

Aug. 8, 2018

On November 1st, the sixth year of open enrollment on the ACA Marketplace will start. While the basic rules that govern the Marketplace and the sliding-scale subsidies remain intact, gains in enrollment are unlikely given the end of penalties for the individual mandate, the emergence of association health plans, and new rules related to “short-term limited duration.”

Reimbursement Rates for Primary Care Services: Evidence of Spillover Effects to Behavioral Health

Jul. 30, 2018

Johanna Catherine Maclean, Chandler McClellan, Michael F. Pesko, Daniel Polsky

Abstract [from journal]

We study spillover effects of the largest ever increase in Medicaid primary care reimbursement rates on behavioral health and healthcare outcomes; mental illness, substance use disorders, and tobacco product use. Much of the variation in Medicaid reimbursement rates we leverage is attributable to a large federally mandated increase between 2013 and 2014 through the Affordable Care Act. We apply differences-in-differences models to survey data specifically designed to measure behavioral health outcomes over the period 2010 to 2016. We find that higher...

Acuity-Based Scheduling in Primary Care

Jul. 25, 2018

ABSTRACT [FROM JOURNAL]

Objectives: Triage algorithms are ubiquitous in emergency care settings, but the extent of their use in primary care is unknown. This study asks whether primary care practices prioritize patients with more acute service needs.

Methods: We used an audit study in which simulated patients were randomized to 2 clinical scenarios—a new patient seeking a routine check-up or a new patient seeking treatment for newly diagnosed hypertension—and attempted to schedule appointments with thousands of randomly selected primary...

Modernizing Medicare Funding for Nurse Education

Jun. 21, 2018

With policies rooted in the 1960s, it’s time to change how Medicare pays for nurse education. In a New England Journal of Medicine Perspective, LDI Senior Fellow Linda Aiken and colleagues present a compelling case for funding a new consortium model that trains nurse practitioners (NPs) in the community settings where they are a crucial source of primary care.

Integrated Behavioral Health Care in Family Medicine Residencies: A CERA Survey

Jun. 13, 2018

Christine Jacobs, Jay A. Brieler, Joanne Salas, Renée M. Betancourt, Peter F. Cronholm

ABSTRACT [FROM JOURNAL]

Background and Objectives: Behavioral health integration (BHI) in primary care settings is critical to mental health care in the United States. Family medicine resident experience in BHI in family medicine residency (FMR) continuity clinics is essential preparation for practice. We surveyed FMR program directors to characterize the status of BHI in FMR training.

Methods: Using the Council of Academic Family Medicine Educational Research Alliance (CERA) 2017 survey, FMR program directors...

Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial

Research Brief
Feb. 7, 2018

In a pragmatic trial, offering complimentary ridesharing services broadly to Medicaid patients did not reduce rates of missed primary care appointments. The uptake of free rides was low, and rates of missed appointments remained unchanged at 36%. Efforts to reduce missed appointments due to transportation barriers may require more targeted approaches.

New OECD Report Highlights Expanded Primary Care Role for Nurses

Jan. 9, 2018

To meet population health care needs in developed countries, health systems must shift their focus from treating acute episodes to managing chronic conditions. With the rise of chronic care comes a new set of tasks that are more time-consuming and team-oriented. Policymakers in many countries are seeking to align the size and composition of their primary care workforce to meet these new needs, by expanding the role of advanced nurses.

Changing Antibiotic Prescribing in a Primary Care Network: The Role of Readiness to Change and Group Dynamics in Success

Oct. 11, 2017

Suratha Elango, Julia E. Szymczak, Ian M. Bennett, Rinad S. Beidas, Rachel M. Werner

In the American Journal of Medical Quality, Suratha Elango and colleagues, including Rinad Beidas and Rachel Werner, studied factors important to combating overuse of broad-spectrum antibiotics in outpatient pediatric practices. Primary care clinics in the Children’s Hospital of Philadelphia network completed surveys and then semi-structured interviews on barriers and facilitators to improving their antibiotic prescribing practices, perceptions and reactions to the initiative, and the climate surrounding its implementation.

Practices with a high willingness...

A ‘Newfound Passion for Advocacy’

Sep. 26, 2017

The American College of Physicians (ACP), representing 152,000 internal medicine physicians and medical students, has been front and center in the national debates on health care reform, according to Robert Doherty, the ACP’s Senior Vice President of Governmental Affairs and Public Policy. The ACP is the largest physician specialty society and second largest medical organization in the United States.

Networks in ACA Marketplaces are Narrower for Mental Health Care Than for Primary Care

Research Brief
Sep. 5, 2017

In 2016, ACA marketplace plans offered provider networks that were far narrower for mental health care than for primary care. On average, plan networks included 24 percent of all primary care providers and 11 percent of all mental health care providers in a given market. Just 43 percent of psychiatrists and 19 percent of nonphysician mental health providers participate in any network. These findings raise important questions about network sufficiency, consumer choice, and access to mental health care in marketplace plans.

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