1. The Successful Primary Practice
Terry Cunningham, DBA, MHA
Chief Operating Officer
Palmetto Primary Care Physicians, LLC

2. Who is Palmetto Primary Care Physicians?

3. Leaders in Primary Care
Our History:
Early 90s, managed care HMO’s were being formed on the West Coast of the US. Physicians had obvious concerns that insurance companies and government controls of healthcare delivery systems would expand to the East.
The concern of managed care led 3 primary care groups in Dorchester County (SC) to begin discussions over a “clinic without walls“ business model. The doctors met frequently with the idea of forming a single group that would mean better ability to fight managed care.
Palmetto Primary Care Physicians formed in January Early offers by hospitals to purchase the group would be entertained but always declined by the physicians.  
The desire was to remain independent!

4. Leaders in Primary Care
Our Present:
Today PPCP has grown to serve over 200,000 patients throughout 33 primary and specialty care offices in 5 counties.
We employ over 575 clinical and non-clinical staff members, including 46 physicians and 54 mid-levels.
Our services have grown to include:
Neurology
Endocrinology
Gastroenterology
Psychology
Urgent Care Center
Lab
Imaging
NEW!

5. Leaders in Primary Care
PPCP Market:

6. Leaders in Primary Care
Our Future:
Became an Accountable Care Organization (ACO) in This will move us into the future by:
Improving quality while reducing costs
Incentivizing us to create stronger partnerships with community health organizations towards a common goal
Strengthen our competency in team-based patient care

7. Leaders in Primary Care
Our Future:
Launch a Management Service Organization (AVANT MSO)
Providing an “open menu” of services, available on an “al la carte” basis
Empowering small offices to access needed services while remaining independent
Allowing independent physicians to “digest small bites” in the movement toward integration with a larger group of physicians
Enabling Clinically Integrated Networks to share a unified electronic medical record, without unified employment relationships

8. What does Primary Care look like today?

9. Understanding Primary Care Today
Legislation has created more demand for primary care services (think ObamaCare), but less primary care physicians are entering the market – creating a high demand, but lack of supply
Increased demand for data and performance based metrics are demanding more of the physician’s time while they are with the patient (ie. Meaningful Use data)
Industry is ‘transitioning’ from fee for service to fee for value. Most practices are moving into team focused patient care, however, not seeing the full monetary benefits of it yet…and won’t for a few years!
Healthcare is still largely fragmented when it comes to delivery of care. Independent practices are required to collaborate with other healthcare providers in the community in order to provide the communication and level of care expected by patients.

10. Understanding Primary Care Today
Patients are now CONSUMERS, not just patients!

11. The ‘Mechanics’ of Primary Care

12. Imaging (including Mammo)
Process Flow
Primary Care
Urgent Care Center
Gastroenterology
Care Coordination
Psychiatry
Lab
Imaging (including Mammo)
Neurology

13. Advanced Practitioner (NP/PA) Ratio
Rule of thumb 3 AP’s for 1 physician
In order to improve efficiency, practices can have their advanced practitioners see patients who need basic preventative care and those who need to be seen for straight-forward acute illnesses or uncomplicated chronic conditions. This frees up the physicians to see the more complicated patients.

14. Care Coordination
Leadership

15. Care Coordination
Examples:

16. The Future of Primary Care

17. The Future of Primary Care
Patient-centered care
Improving outcomes for patients with chronic illnesses
Focus is on reducing costs (minimizing re-admissions to ER through preventative care, reducing long term hospitalizations)
Strengthen the physician-patient relationship
Tele-Medicine
Reimbursements focused on Patient Satisfaction

18. QUESTIONS?????