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Primary care physicians unprepared to lead community-based primary care hubs, says PwC

The survey found that 68 percent of primary care practices are ill-equipped to manage patients' social needs.

Jeff Lagasse, Associate Editor

Increasingly in healthcare, community-based primary care hubs coordinate specialty medical and nonmedical services on behalf of the patient, while primary care physicians lead efforts to improve results for both patients and health systems. But many primary care doctors are unprepared for this role, according to an analysis by PricewaterhouseCooper's Health Research Institute.

The survey found that 68 percent of primary care practices are ill-equipped to manage patients' social needs. Fewer than 50 percent say they coordinate with the right social service agencies. Many believe they lack the knowledge and skills to counsel patients on physical activity, nutrition, mental health issues and cost.

Academic medical centers and medical schools may lose out if they're not properly prepared for this shift, the analysis found, as the U.S. government pumps billions of dollars into primary care improvement and innovation.

New payment models, such as the National Council on Quality Assurance's patient-centered medical home model and Medicare accountable care organizations, also elevate the role of primary care. The Centers for Medicare and Medicaid Services is pushing to have 50 percent of Medicare payments in value-based payment models by 2018.

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For medical schools to adequately prepare primary care doctors for this new landscape, they'll have to teach their students how to identify the community organizations they should be working with, or the data sources they should be using, according to HRI. And the aspiring doctors should understand the environmental and social aspects that affect people's health.

There's work to do in that regard. Only 31 percent of medical schools required longitudinal, integrated clinical experiences that allow students to follow a set of patients and build relationships over time, HRI's research showed. Traditionally, medical schools teach basic sciences in the first two years, followed by two years of rotational clinical experience, which usually lacks continuity. It offers minimal time in ambulatory or community settings, where there's more opportunity to work with patients on disease management and prevention. That, according to HRI, will have to change to adapt to the current landscape.

Leading medical schools are immersing students in underserved communities, where people tend to have more chronic, social and mental health conditions. The majority of the new medical schools that have opened since 2005, and those in development, have built their programs with the primary aim of catering to medically underserved communities.

Some traditional medical schools are also emphasizing community health by opening new schools or expanding existing ones on regional campuses. And certain programs are integrating a whole health and public health focus into the curriculum.

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Primary care providers are starting to broaden their team of non-physicians to cater to specific, holistic needs of certain consumer segments -- which medical schools also need to prepare for. Sixty-eight percent of primary care doctors, for example, said they want mental health professionals on their team, but just 15 percent of medical schools surveyed by the 2015 Liason Committee on Medical Education said they require training with such professionals.

Medical students also need to learn the business side of healthcare, according to HRI, necessitated by the shift to value-based care models. That means they should understand how billing and collections work; after all, for many of them, a portion of their compensation is tied to collections.

Some medical schools are responding. From 2007 to 2015, the percentage of medical schools offering combined medical doctorate and master of business administration degrees grew from 29 percent to 44 percent.

Twitter: @JELagasse

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