Primary Care Resource Gaps and Healthcare Reform

Healthcare reform has occupied the political landscape for more than a decade. Numerous efforts to address the under and uninsured population have been proposed. Many of these proposals have been fraught with complexity and none have included a mechanism to measure the impact on current hospital/physician delivery systems. A model designed to anticipate future staffing needs of a relatively unknown patient population requiring primary care was developed for a 9 hospital system as part of a larger medical staff resource strategy study. The model utilized NAMCS - CDC survey data estimating uncompensated care (health reform's target audience) provided in the private practice office setting (specialty specific) correlated with hospital system indigent care utilization data. Epidemiologic analysis of emergency department utilization (a proxy for underlying disease in this population) found a prevalence of poorly managed chronic disease with many patients presenting with multiple comorbid conditions. Findings from this pilot study highlight the likelihood of a significant disruption in existing primary care access attributed to healthcare reform. Two complementary strategies were formulated: one addressing current and anticipated future physician access and capacity constraints. A second strategy evaluated development of diagnosis specific delivery models designed to meet chronic care disease burden given current staffing levels. This session is designed to provide participants with insight to one methodology to estimate likely post-reform demand for services and consider alternative delivery strategies to meet chronic disease demand given current and anticipated future constraints in physician resource availability.