A primary care fable
A wealthy owner of a large company is eager to reduce the cost of providing heath care to his employees. Intrigued by an Erika Bliss quotation, he vows to learn whether slowing down the pace of primary care delivery really lowers overall health resource utilization. He decides to build a complete employee primary care center that includes a pharmacy dispensing basic medications, a basic laboratory, a basic x-ray service and/or everything else deemed appropriate by his advisory board of primary care experts.
For the primary physicians, he builds two separate wings. He selects at random exactly 3000 employees to receive their primary care in each wing. He staffs the “Hare” Wing with precisely the number of PCPs needed to provide an average primary care appointment time of 22.5 minutes to sixteen patients each day. He staffs the “Tortoise” wing with precisely twice that number of PCPs, expects them to have 45 minute appointments, and see eight patients per day. In the Hare wing, this requires two physicians, each has a panel of 1500 patients; in the Tortoise wing, this requires four physicians, each with a panel of 750. Each of the six PCPs receives $250,000 per year in compensation.
Deployment of Tortoise Care represents a larger demand for primary health care resources, by $500,000 above that for Hare Care .
If the Tortoise Care employees as a group use $400,000 less in downstream care resources, deployment of the Tortoise Care model will still have increased the net level of demanded health care services by $100,000.
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