Primary Care

Defining key terms:

  • Primary Care: Health services that cover a range of prevention, wellness, and treatment for common illnesses. Primary care providers include doctors, nurses, nurse practitioners, and physician assistants. They often maintain long-term relationships with patients and advise and treat a range of health-related issues. They may also coordinate a patient’s care with specialists. (https://www.healthcare.gov/glossary/primary-care/)
     
  • Preventative Care: Routine (or regular) health care that includes cancer screenings, vaccines, check-ups, and patient counseling to prevent illnesses, disease, or other health problems. (https://www.healthcare.gov/glossary/preventive-services/). Examples include an annual wellness or “Welcome to Medicare” visit.
     
  • Care Coordination: The organization of an individual’s care across multiple health care providers. (Healthcare.gov).

Primary care is important for patient health

Primary care doctors are important for keeping patients healthier, longer. They can focus on certain age groups, like pediatrics (kids) or geriatrics (older adults), or may be able to provide health care for an entire family.

Image showing care provider in white lab coat consulting with a patient

Primary care doctors often have long-term care relationships with patients and their caregivers, making them more alert to changes in a patient’s health. They may also serve as an “entry point” to health care for a patient without a clear diagnosis. They can help patients navigate the sometimes-complex health care system by coordinating with other specialists, making referrals and staying on top of chronic diseases.

Annual wellness visits and other health screenings performed by a primary care doctor can help uncover conditions, such as prediabetes, early. This can give the patient time to consider their health goals, and work with the primary care doctor to develop a care plan they can follow instead of ending up in the hospital or needing more intensive care.

Primary care doctors can provide care such as immunizations, bloodwork, or treating minor infections. They are trained to monitor and treat a wide range of common health issues, such as diabetes and high blood pressure.

How primary care can help patients

The example below illustrates how patients can benefit from primary care.

Uncovering a new diagnosis

John, 65, schedules a visit with his longtime primary care provider, who reviews John’s medical history and health complaints. John has felt more tired than usual lately. The physician orders routine blood work such as the complete blood count (CBC) test, calculates John’s body mass index, and screens John for symptoms of depression. The CBC test comes back with a red flag – John is severely anemic. The primary care provider refers John to a hematologist, who runs further tests and uncovers myelodysplastic syndrome, a rare form of blood cancer. The hematologist and primary care provider work together to develop a short and long-term care plan for John.

CMS Innovation Primary Care Models

Several CMS Innovation Center models focus on primary care because of a primary care provider’s role in preventative care and care management. If a patient’s condition is caught and treated early and managed properly, they may be healthier and less likely to use more expensive forms of health care such as the hospital emergency department. A good primary care provider can serve as a coordinator between various other clinicians and specialists, potentially delaying the onset or progression of a chronic disease, like high blood pressure.

Some CMS Innovation Center models that focus on primary care include:

Additional Information

Originally posted on: August 14, 2023

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