Team Based Primary Care - Part 1 : Why Team Based makes sense

Patient healthcare in a Primary Care model is owned by the Primary Care Physicians (PCP) as they receive all notes, labs and refill requests for their patients. Patients select their PCPs who then become responsible for every aspect of their healthcare. The workload on a PCP is measured in terms of the "panel size", defined as the number of unique patients under the PCP care. Generally, this count is based on the last 18 months, though occasionally a 12 month period is used. the 12 month period may result in under estimation as not every patient visits their PCP in a given 12 month period.

An ideal panel size under the traditional Primary Care model is about 1000. The US national average panel size for PCPs is about above 2000. The reason for such large panel sizes is the number of PCPs available for the patient population, which is at 1 PCP available for every 1500 patients, and this includes those physicians who are not working full-time.

The demand and supply differential causes variation in panel sizes. Demand is the number of patients seeking primary healthcare services and supply is the number of available appointment slots. Ideal situation is when Demand equals Supply.

Demand = number of unique patients seen by PCP in the last 18 months X visits per patient per year.
Supply = Appointment slots available per day X Provider days per year.

In the current situation with less number of PCPs available and more patients seeking primary care, the demand supply balance is tilted heavily towards demand, and the supply side has to overload themselves to keep it balanced.

One way to balance the panel size is to increase the supply, meaning increase the number of PCPs, which is only possible by a long time concerted and consistent effort and depends  upon more physician willing to join the PCP ranks.

Another option is to offload the PCPs by adding Nurse Practitioners and Physician Assistants to provide primary care by maintaining their own panels. This can be augmented by delegating those services that do not require clinician level training, to non-primary care personnel and to technology. Primary candidates for such delegated services are preventive and chronic care. Hence, it becomes a team based model where a team of care professionals and technology combine to share the load thereby offsetting the imbalance between demand and supply. In a team based primary care model, the panel size can be maintained between 1200 and 1500 for a PCP, which actually corresponds to the current supply of PCPs in the US. 

Additional costs incurred for implementing a team based model are training and technology. Exact numbers would vary depending upon the patient population age and health spread.

Implementing a team based primary care model requires a cultural and structural change in the practice, including clinicians' mindsets, training, re-mapping of workflows and most importantly patient education. Primary Care payment system would also require modification. 

Successful team-based Primary Care healthcare services result in increase in patient satisfaction, better overall health and wellness in the patient community, and at the same time providing a reasonable work life for all members of the Primary Care Team.