Will Health Reform Bring New Role, Respect To Primary Care Physicians?

A few years ago it struck the D.C. region’s biggest medical insurer that the doctors who saw its members most often and knew them best got the smallest piece of the healthcare dollar. CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs and specialty physicians to treat sick patients. Only one dollar in 20 went to the family-care doctors and other primary caregivers trained to keep people healthy.

The company’s move to shift that balance tells a lesser-known story of the Affordable Care Act and efforts to change the health system.

While much attention has focused on expanded coverage and online insurance bazaars, policymakers’ bigger challenge is improving Americans’ health while putting a brake on the cost of their care. The keys to that puzzle, CareFirst and many others are deciding, are the internists and general practitioners who have largely been left behind by health care’s financial boom.

“As long as I can remember, family physicians and general internists have been financially at the low end of the totem pole,” said Michael Merson, a consultant and former hospital executive who was CareFirst’s board chairman until 2012. Raising their pay for the unglamorous work of preventing expensive illness and coordinating care, he said, “was really our starting point.”

Beginning in 2011 CareFirst increased reimbursement for what would soon be most of its primary care doctors in Maryland, the District and Virginia. It began paying even more if they reduced duplicative, unneeded or overly-expensive treatment while maintaining or improving quality.