The Harvard Business Review tried their best to see who is saving primary care. The article is called Can New Players Revive U.S. Primary Care? and it is all about corporations like CVS-Aetna, Walgreens, Walmart, Amazon, Optum-United Health Group attempting to capitalize on our broken system.

Observing the U.S primary care vacuum, companies that work at the periphery of direct service delivery — insurers and retailers that sell drugs and medical supplies — have sensed opportunity. Some, such as CVS-Aetna, began by experimenting with now-familiar “minute-clinics”that employ nurses and pharmacists in retail facilities to offer immunizations and treatment of basic problems such as colds, sinus infections, and urinary tract infections.

Some venture-backed companies have gone a step further by creating new models of primary care in which PCPs assume financial risk for the cost and quality of all or part of their patients’ care in return for an upfront, annual payment, sometimes called capitation. These ventures calculate that they can reduce the waste in the system, reap the savings, and thereby improve the compensation and working conditions of primary care providers while creating a bottom line for investors.

Are you disgusted yet? I am. Want more:

There are three basic routes that companies could travel to revive primary care:

– First, retailers can treat primary care services as a loss leader to attract more customers to their retail facilities and use the profits to cross-subsidize primary care.

– A second strategy is to make primary care itself more profitable under the current fee-for-service conditions by increasing its productivity. 

– Some are pursuing a third strategy, which is by far the most promising. It especially makes sense for the Optum-UHGs and CVS-Aetnas of the world. They already assume financial risk for the cost of care on behalf of their fully insured clients and manage those expenses for clients who are self-insured.

That’s all we are to these people: loss leaders, productivity pawns, or expense managers. Is that what we went into primary care to do? This is the hope for the future of primary care?

The only hope for us is DIRECT PRIMARY CARE. It is a system where we have agency in our career, feel valued, give time to patients, and don’t burnout. Feel free to contact the author David Blumenthal, MD, who has no clue about us.