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Primary care physicians should be coordinators, not gatekeepers.

T Bodenheimer1, B Lo, L Casalino

  • 1Department of Family and Community Medicine, University of California at San Francisco School of Medicine, USA.

JAMA
|June 8, 1999
PubMed
Summary
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Primary care physicians (PCPs) should shift from gatekeepers to care coordinators. This new model integrates primary and specialty care to enhance patient outcomes and quality, moving beyond cost-reduction goals.

Area of Science:

  • Health Services Research
  • Medical Economics
  • Primary Care Medicine

Background:

  • Current primary care gatekeeping models, focused on limiting specialist referrals for cost reduction, are inadequate for optimal medical practice.
  • The alternative of uncoordinated open access to specialists also presents significant drawbacks.

Purpose of the Study:

  • To propose a revised primary care model where physicians act as care coordinators rather than gatekeepers.
  • To outline necessary changes in physician workflow, referral processes, and payment structures to support this new model.

Main Methods:

  • Conceptual model development for primary care physician (PCP) as a care coordinator.
  • Discussion of necessary systemic changes including referral authorization, payment incentives, and specialist budgeting.

Related Experiment Videos

Main Results:

  • The proposed model eliminates mandatory PCP or managed care organization authorization for specialist referrals.
  • It suggests financial incentives for PCPs to manage complex cases and optimize specialist referrals.
  • Specialist budgeting is proposed to manage costs after gatekeeping removal.

Conclusions:

  • Transforming PCPs into care coordinators can improve the integration of primary and specialty care, enhancing overall quality.
  • Pilot projects are essential to test and refine the PCP as a coordinator of care model.