Health affairs
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Medical care and primary care were at one time synonymous. All health care was primary. ⋯ The essential point is that "primary care" was born out of tension with other forms of medical care. In the future, primary care will be reinvented, and changes will be caused by the sorts of external social, political, and economic forces that previously led to systemic transformation.
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The concept of accountable care organizations (ACOs) has been set forth in recently enacted national health reform legislation as a strategy to address current shortcomings in the U. S. health care system. ⋯ We seek to clarify definitions and key principles, provide an update on implementation in the context of other reforms, and address emerging issues that will affect the organizations' success. Finally, building on the initial experience of several organizations that are implementing accountable care and complementary reforms, we propose a national strategy to identify and expand successful approaches to accountable care implementation.
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Existing research suggests that models of enhanced primary care lead to health care systems with better performance. What the research does not show is whether such an approach is feasible or likely to be effective within the U. ⋯ We analyze potential barriers to implementing the medical home model for policy makers and practitioners. Among others, these include developing new payment models, as well as the need for up-front funding to assemble the personnel and infrastructure required by an enhanced non-visit-based primary care practice and methods to facilitate transformation of existing practices to functioning medical homes.
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Patients value the interpersonal aspects of their health care experiences. However, faced with multiple resource demands, primary care practices may question the value of collecting and acting upon survey data that measure patients' experiences of care. ⋯ Collecting and reporting CAHPS data can improve patients' experiences, along with producing tangible benefits to primary care practices and the health care system. We also argue that the use of patient experience information can be an important strategy for transforming practices as well as to drive overall system transformation.
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Nurse practitioners are the principal group of advanced-practice nurses delivering primary care in the United States. We reviewed the current and projected nurse practitioner workforce, and we summarize the available evidence of their contributions to improving primary care and reducing more costly health resource use. We recommend that nurse practice acts--the state laws governing how nurses may practice--be standardized, that equivalent reimbursement be paid for comparable services regardless of practitioner, and that performance results be publicly reported to maximize the high-quality care that nurse practitioners provide.