MOUNT SINAI JOURNAL OF MEDICINE 79:423–424, 2012 423

THEME INTRODUCTION

Primary Care: Healthcare’s Leading EdgeAida Vega, MD and David C. Thomas, MD

Mount Sinai School of Medicine, New York, NY

There is widespread agreement by many professionalsocieties, consumer groups, public policy advisers,and health plans that primary-care providers willbe major drivers behind changes in healthcaredelivery. Primary-care providers comprise mostlygeneral internists, pediatricians, family physicians,and nonphysician providers. Studies suggest thatprimary-care providers have lower levels of use ofdiagnostic tests and procedures, resulting in equal tolower costs of care as compared with specialists.1 Inaddition, primary-care providers have been linked toimproved quality of care. Patients who have long-term clinical relationships with a provider are morelikely to receive preventive care.1 Patients who havea ‘‘usual source of care’’ are more likely to be satisfiedwith their healthcare and have fewer emergencyroom visits. Continuity of care has also beenassociated with lower rates of hospital admissionsand lower costs.1 In this issue of the Mount SinaiJournal of Medicine, we provide a review of thecurrent state of primary care and future directions.

Primary-care systems redesign, such as thepatient-centered medical home (PCMH) and thechronic care model, as described by Arend et al.in this issue, offers promise for delivering patient-centered care and improving patient satisfaction,access to care, care coordination, and healthoutcomes through team-based care and populationmanagement. The article also discusses options forreimbursement reform, which will be a key factor in

Address Correspondence to:

Aida VegaDepartment of Medicine

Mount Sinai Medical CenterNew York, NY

Email: aida.vega@mountsinai.org

determining success of any redesign of the healthcaresystem. One such model is the proposed Medicareaccountable care organizations, which reimbursegroups of physicians and hospitals in a networkfor improving quality and reducing costs.

Health information technology is an essentialcomponent for population management and formeeting the requirements of the PCMH and thechronic care model. In this issue, Molina-Ortizet al. describe how chronic-disease registries can befunctionalities embedded in an electronic medicalrecord for meeting disease-specific evidenced-basedguidelines at the institutional level and for reportingto payers and regulatory agencies. Disease registrieswill be an essential component going forward fordelivering effective, quality care.

Patients with complex and chronic medicalproblems often have mental health issues such asdepression and anxiety. They also often exhibitincreased utilization of health services and poorcompliance with prescribed treatment plans. In thisissue, Cerimele et al. describe models for improvingcare coordination and treatment for patients withchronic medical problems and comorbid psychiatricconditions. The PCMH model lends itself to carecoordination that includes mental health services.

Home-based primary care is gaining resurgenceas a mode of delivering healthcare to the vulnerablepopulations in the United States with physicaland cognitive limitations. In this issue, DeCherrieet al. describe the different models of home-basedprimary care. They also highlight the benefits ofthis form of healthcare delivery, which includereduction in emergency room visits and unnecessaryhospitalizations for patients with complex medicalproblems.

Effective change in the delivery of healthcaremust be dovetailed with retraining of the workforce.Peccoralo et al. discuss the necessary changes inmedical-school curricula, both at the undergraduate

Published online in Wiley Online Library (wileyonlinelibrary.com).DOI:10.1002/msj.21325

© 2012 Mount Sinai School of Medicine

424 A. VEGA AND D. C. THOMAS: PRIMARY CARE

and graduate level, that are currently underwayto meet the needs of our changing healthcaresystem. Additionally, Jonathan Ripp et al. detailthe rise in noncommunicable diseases worldwideand the need to integrate training on globalhealth and primary care in order to address thehealth requirements of vulnerable populations at aninternational level.

Effective change in healthcare delivery cannotbe sustained without changes in how primary-careservices are reimbursed. Physician compensation andevaluation by employers and payers is undergoingreform as well. Arik Olson et al discuss the disparitiesin salaries between primary-care physicians andspecialists and describe better ways to evaluateand reward primary-care providers based on qualityoutcomes, care coordination, and complexity of thepatients in their panels.

Academic medical centers are well positionedto be leaders in healthcare reform. Innovative train-

ing programs in primary care and global health,both at the graduate and undergraduate levels,will help develop the future leaders of health-care delivery. This issue provides an overviewof how primary-care systems and training needto develop in order to accomplish true health-care reform and improvement in the health of thepopulation.

DISCLOSURES

Potential conflict of interest: Nothing to report.

REFERENCE

1. Friedberg MW, Hussey PS, Schneider EC. A criticalreview of the evidence on quality and costs of healthcare. Health Aff (Millwood) 2010; 29: 766–772.

DOI:10.1002/MSJ