Primary care innovation needs more than money

Much has been recently made about the bureaucratic obstacles that primary care doctors face. With good reason.

The impetus was a recent New England Journal of Medicine paper from Richard J. Baron that I mentioned recently.

The New York Times’ Pauline Chen interviewed Dr. Baron, who shared some interesting insights on what needs to be done.

He contrasts the inertia in primary care to drug manufacturing. If you took the resources that went into drug development, for instance, “and put them into a program like this that achieves meaningful levels of behavior change, a lot more patients could be better off.”

In other words, research into new primary care models isn’t taking off because the money isn’t there.

But Dr. Baron also notes that money isn’t everything, since “primary care practitioners have been saying that we either already do or would do certain things if you paid us more. It’s true that you can’t do things consistently, reliably and across scales without additional payment. But payment is not enough. People have to change what they are thinking about when they go to work.”

And I agree — it has to be more than money. Lifestyle and practice environment need to be concurrently improved and should be placed on par with better financial resources to innovate primary care delivery.

If nothing is done — health reform does little to change the underlying payment system — funneling more dollars into the current primary care system will only entrench a dysfunctional model, where, “certain kinds of behaviors flourish and some, like the collaborative care model we are trying to use, don’t.”

There has to be political will to disrupt the primary care system and implement these new models. But after seeing the seismic controversy last year that yielded incremental health reform, I’m not optimistic that’s happening anytime soon.


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