Primary Care Practice: The Structures and Methods Associated with Community-Based Primary Practice

Abstract

This chapter reviews the myriad factors that influence the character and quality of community- based primary care and ultimately the care experienced by the patient. To understand the work of community-based PCPs, all these factors need to be considered. An abbreviated list of these factors follows:

• REIMBURSEMENT:

• Managed care

• The rationale for HMO type of care payment arrangements: the traditional fee-for-service model versus shared savings

• Reconciliation of the disparate interests of practitioner and economy of practice

• Accountable care organizations (ACOs)

• CARE DELIVERY, COMMON TYPES:

• Solo practice

• Multi-specialty group practice

• Major medical center

• WHO DELIVERS THE CARE?

• Primary care physicians

• Physician assistants

• Nurse practitioners

• Other physician support and supplement personnel

• Care managers and case managers

• COORDINATION OF CARE:

• Collaborative (integrated) care

• Patient-centered medical home (primary care)

• The Medical-Psychiatric Coordinating Physician Model of Care (MPCP)

• Administrator-led models