Defining key terms:
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.
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:
- Primary Care First Model Options
- The Maryland Primary Care Program (MDPCP), part of the Maryland Total Cost of Care Model
- ACO Realizing Equity, Access, and Community Health (REACH) Model
- The CMS Innovation Center’s Strategy to Support High-Quality Primary Care - CMS Blog (June 9, 2023)
- Purva Rawal, Jacob Quinton, Dora Hughes, and Liz Fowler
- CMS Innovation Center Primary Care Models Comparison