After reading the two articles as background, let's talk a bit more about the new primary care delivery models underway. These models are often called medical homes or direct primary care. Iora Health is a company that was started around the time that the Affordable Care Act or ACA was passed. Their hope was to change the dynamics of healthcare delivery and payment, to move away from paying for volume and intensity towards paying for health. Similar to patient-centered medical homes, they believe that increased use of primary care services would result in lower overall cost and improved health outcomes. Cost reductions come from less frequent hospitalizations, emergency room visits, procedures, and specialty care. Well-coordinated care with health information exchange also contribute to less duplicative services and errors. Their team-based approach allows all members of the primary care team including MDs, NPs, and PAs, those are doctors, nurse practitioners, and physician assistants, behavioral health professionals, and others to work at the top of their license. With the team-based approach, they are able to focus on the whole patient as opposed to each individual symptom or condition. Spending time with patients to help them understand their health and how to manage chronic illnesses while minimizing out-of-pocket expenses helps cultivate an environment of engaged consumerism and decision making. Proactive patient outreach and prevention focus also contributes to avoidance of undesirable clinical and cost situations like hospitalizations. Iora Health works directly with insurers and employers to provide an alternative to the traditional primary care model. Employers who often fund a large portion of health insurance premiums and costs recognize that they need to introduce new models to manage their healthcare costs while improving employee health and productivity. Financial savings can be quantified for employers by comparing the savings from reduced high-cost acute services like hospitalizations, emergency room visits, specialty visits, and procedures that are offset by higher costs for primary care. There may also be higher costs for prescription drugs and labs, as patients are more compliant with their medications and monitoring of their conditions. Improved productivity is more difficult to quantify. However, evaluation of sick time use, as well as employee satisfaction and engagement are good measures of the program success. So, there are clear benefits to the purchasers, both employers and insurers from this model. But what about the patient and the consumer? This may mean that employees need to establish new relationships with PCPs who are participating in this model. Would you be willing to do this, recognizing that your employer is paying 70-80 percent of your healthcare costs? What if your employer offered you a choice with an incentive, real money? If you were willing to try out the new physician under this model, what would you do?