What providers want from the Primary Care Extension Service to facilitate practice transformation

While several experts have shared their visions of the Primary Care Extension Service (PCES) as called for in the Affordable Care Act (ACA), little is known about providers' perspective. We aimed to identify the most and least desired resources that primary care providers want from the PCES.

A 70-question survey was administered to primary care providers (n=556) in Pennsylvania, one of four initial states chosen to develop the PCES infrastructure. Analysis focused on the highest and lowest ranked questions.

The most desired PCES services include (1) identifying and coordinating mental health services, (2) improving office efficiency, (3) increasing overall revenues, and (4) strategies to help implement evidence-based clinical guidelines. The least desired PCES services include (1) implementing e-prescribing, (2) implementing an electronic medical record (EMR) system, (3) implementing group visits, (4) recruiting new patients, and (5) implementing open or advanced access scheduling.

Despite expert models presented for the PCES, there is a critical need to ask primary care providers what they need from such a service. Our findings identified some divergences from key patient-centered medical home (PCMH) components, including the low ranking of services related to EMRs and increasing patient access. With interest growing in developing a PCES that would help spread innovation as outlined in the ACA, it's important to take a demand-side approach to the services providers most desire versus the more traditional supply-side approach that assumes the assistance providers need.