Coordinated care vs. primary care: what's the problem and what's the solution?

Over at CommonHealth this week, Debra Geihsler proposes a coordinated care model as a solution to the looming PCP crisis.  (Debra is CEO of Harvard Vanguard Medical Associates, which, for those of you not from around here, is the not-for-profit medical group that used to be the staff part of former part-staff-model HMO Harvard Community Health Plan; the HMO is now Harvard Pilgrim Health Care.)

This sounds like an intriguing idea, but the solution seems to be constructed from the perspective of the provider and payor (lack of PCP resources, high cost of chronic care) rather than the public (though she does note the access issue — i.e., lack of timely access to PCPs).

I wonder, to what extent has HVMA implemented this approach?  To what extent can it do so without changes in payor contracts?

I’d be interested in hearing more about what HVMA means, exactly, by coordinated care.  As described by some other provider organizations, it sounds to me just like what the function of a good PCP is supposed to be.

My own care through HVMA seems to be coordinated through my PCP, through annual physicals and advice about things like diet and exercise, as well as through encounters with the system between annual physicals.

In the face of a PCP-MD shortage, does coordinated care mean that I will eventually have an NP/PA but not an MD as my primary care provider?  What approaches will be put in place to be sure that the care is more coordinated, rather than less coordinated, in the absence of a PCP?

As always, the devil is in the details.

Update 6/29/07:  More on the problem:  The Center for Studying Health System Change released today a study on the drop in numbers of primary care physicians.  The Center says:

An exodus of men from primary care practice is driving a marked shift in the physician workforce toward such specialties as cardiology and dermatology, reinforcing concerns about a looming shortage of primary care physicians, according to a new national study released today by HSC.

Two factors have helped mask the severity of the shift from primary care — a growing proportion of female physicians, who disproportionately choose primary care, and continued reliance on international medical graduates (IMGs), who now account for nearly a quarter of all U.S. primary care physicians, according to the study.

See the study and press release.

— David Harlow