What can we do to expand patient access to primary care?

The lack of investment in primary care physicians and mid-level professionals is expected to be a challenge moving forward. Its clearly a challenge to managing the costs of health care in the future. In reality we already have a primary care shortage in many parts of the country including rural and low-income urban areas.

Today, at a 340B related conference in San Diego, Dr Mary Wakefield, Administrator, Health Resources & Services Administration emphasized the investment of the Health Reform (Affordable Care Act) in ensuring primary care physicians are encouraged and funded to work in under served communities, also investments in pharmacy care services in these communities are being funded to help patients have access to care. Programs and changes are rolling out now to help those who previously did not have access in rural and remote communities to have more choices.

The hope is these investments will address the projected gaps in access to primary care resources. Suggestions we have heard include:

• Expanding the role and reimbursement of pharmacy care services to support patient education and adherence. Medication Therapy Management (MTM) is a beginning but it needs to be expanded and modest reimbursement to pharmacists could create dramatic savings. Many of the Pharmacy Associations (like APhA) are leading the way with such models.
• Expand the role of community pharmacy to include a wide range of injections. This year we have seen a dramatic increase in the role of pharmacists as the leading site for patient flu shots but clearly many other types of injections could easily and conveniently be provided in the community pharmacy setting with appropriate coverage and reimbursement (including Medicare and Medicaid).
• Expanding the role and appropriate reimbursement for mid-level providers such as nurse practitioners and physician assistants could dramatically expand access to primary care.