1. Comparisons of Restructured Primary Care A Synthesis

2. Common Themes Shortage of primary care “providers” Geographic variability Variability in the types of and numbers of primary care providers Challenges with fragmentation of care, coordination of care, reliable access to vulnerable groups, diminished emphasis on health promotion and disease prevention

3. Common Themes Introduction of interdisciplinary teams Better use of information technologies Challenges with forms of reimbursement for providers Work life balance – especially for those in remote areas “Turf” battles Use of physician extenders

4. Common Themes Experimenting with new models of care Present, but potentially diminishing emphasis on the role of the physician Quality improvement/cost savings associated with effective provision of primary care Physician provider shortages? Variation in practice patterns for physician extenders

5. Common Themes Relatively low physician reimbursement as compared to specialist physicians Efforts at implementing the Patient Centered Medical Home Variability in the skills of primary care providers Recognition of the value of evidence based medicine with less than application

6. Common Themes Need for innovation and concomitant resistance to innovation Inability to effectively assess the value of new models of care Variable funding priorities Similar demographic challenges Unsustainable economic challenges

7. Differences UK, Canada, Australia with significant government involvement associated with universal approach to care based on a primary care model US lacks universal care approach and is far more specialty driven Physician extenders in UK, Australia, and Canada with higher utilization in primary care

8. Differences Physician extenders in the US with significant migration into specialty and or hospital based practices Challenges for role modeling for primary care physicians in US academic health centers Significant medical student debt in the US drives specialty choice Role of the Relative Value Update Commission (RUC) in the US

9. Differences Role of the fee for service approach in the US

10. Questions for the Breakout Helene: -Who or what are the range of health care providers engaged in the provision of primary care? -How are these groups of providers managed -If team based care has been implemented, what is the evidence that efforts have been successful?

11. Questions for the Breakout Bob: -What are the barriers to expanding the networks of providers of primary care? -Are there any levers to rapidly implement change? -Are there “turf” battles and if so, are there reasonable solutions?

12. Questions for the Breakout Lucio: -Are there effective systems in place to appropriately reimburse primary care providers? -If so, how are they managed (i.e. bundled payments, capitation etc)? -Are there providers of primary care who do not expect to be compensated?

13. Questions for the Breakout UK Discussant: -Are there emerging systems of primary care that are developing beyond the medical mainstream and if so, describe them and if possible, their effectiveness? -If there are emerging systems, are there forms of collaboration with traditional networks of care?