The Decisive Moment:  Comment on “Primary Care Utilization and Colorectal Cancer Outcomes Among Medicare Beneficiaries”

Health care in the United States is confronted with a “perfect storm” of unsustainable cost growth driving our national financial crisis, inadequate system performance, and the recent passage of expansive national health care reform. This is a moment of unprecedented opportunity and peril for the health care system as a whole and for primary care in particular. On one hand, the economic and health benefits of a strong primary care system are increasingly recognized as potential (if partial) solutions to our health system challenges. On the other hand, economic incentives exist that overtly encourage expensive, frequently wasteful, often uncoordinated procedural care and a resultant provider workforce heavily skewed toward specialists. Belated recognition of the extent and unsettling societal implications of this “primary care crisis”¹ has led to renewed interest in innovative models of care delivery, such as the patient-centered medical home (PCMH),² and care organization, such as the accountable care organization (ACO)³—both of which require a robust base of PCPs.