Why Controlling Health Care Costs Starts with Primary Care

I cannot begin to count how many times employers have asked me how they can control health care costs.

Over the years, I have tried to sound intelligent and respond with the latest and greatest academic responses that make me sound like an expert. However, I have concluded that the only way to control medical costs is to focus on the primary care practices exam room.

Impactful Decisions

The most impactful decisions on the ultimate cost and delivery of care are the discussions occurring in the primary care exam room. The best primary care exam services are delivered by primary care practices which are certified as Patient Centered Medical Homes (PCMH).

PCMH is a Model, Not a Place

PCMH may sound like a place, but it is not. PCMH is a model of the organization within a primary care practice that incorporates many features that are above and beyond typical primary care practices.

It includes a comprehensive care model that takes into account all of a patient’s physical and mental health care needs, including acute and chronic issues. These services are generally provided by a team of providers including:

• Physicians
• Physicians assistants
• Advanced practice nurses
• Patient centered behavioral health therapists
• Clinical pharmacists
• Care coordinators
• Support personnel such as nurse educators and social workers

These practitioners provide personalized relationships with patients and their families to help them understand how to manage their care. If a patient requires some level of specialist care, the PCMH team coordinates care and follows up with the patient, specialist and hospital. This level of involvement assures a smooth transition of care for the patient through the complex medical system.

Primary Care Practices – Achieving High Levels of Care

To achieve this high level of care, the PCMH team needs to be accessible to all patients with shorter wait times than typical primary care practices. It is essential that the PCMH team provides around the clock availability through a variety of electronic, telephonic and virtual communication opportunities.

Three Levels of PCMH Certifications

There are three levels of PCMH certifications, with Level 3 being the highest available.

In the Dane County area, the only Level 3 PCMH certified medical practices are the clinics of Group Health Cooperative of South Central Wisconsin (GHC-SCW). GHC-SCW focuses solely on the delivery of primary care and delivers a system of advanced primary care.

These additional clinical services include:

• Dermatology
• Sports medicine
• Behavioral health
• Imaging
• Chiropractic
• Physical therapy
• Optometry services
• Podiatry
• Pharmacy
• Complementary medicine

All of the services above are available at the convenient clinic locations throughout Dane County.

Primary Care Practices Offered Through The Alliance

Primary care at GHC-SCW is not simply a mechanism to refer patients into an expensive medical system, but it is a holistic approach to delivering medical care in the least expensive setting – the primary care exam room.

 All the GHC-SCW clinics are available to Alliance members and all members are invited to try what it means to have a Level 3 PCMH experience. In fact, patients should be encouraged to ask their current primary care system why they are not certified as Level 3 PCMH.