Primary care: healthcare's leading edge.

Abstract

There is widespread agreement by many professional societies, consumer groups, public policy advisers, and health plans that primary-care providers will be major drivers behind changes in healthcare delivery. Primary-care providers comprise mostly general internists, pediatricians, family physicians, and nonphysician providers. Studies suggest that primary-care providers have lower levels of use of diagnostic tests and procedures, resulting in equal to lower costs of care as compared with specialists.1 In addition, primary-care providers have been linked to improved quality of care. Patients who have longterm clinical relationships with a provider are more likely to receive preventive care.1 Patients who have a ‘‘usual source of care’’ are more likely to be satisfied with their healthcare and have fewer emergency room visits. Continuity of care has also been associated with lower rates of hospital admissions and lower costs.1 In this issue of the Mount Sinai Journal of Medicine, we provide a review of the current state of primary care and future directions. Primary-care systems redesign, such as the patient-centered medical home (PCMH) and the chronic care model, as described by Arend et al. in this issue, offers promise for delivering patientcentered care and improving patient satisfaction, access to care, care coordination, and health outcomes through team-based care and population management. The article also discusses options for reimbursement reform, which will be a key factor in