Invited Commentary
Oct 24, 2011

The Decisive MomentComment on “Primary Care Utilization and Colorectal Cancer Outcomes Among Medicare Beneficiaries”

Author Affiliations

Author Affiliations: Division of General Medicine and Primary Care, Brigham and Women's Hospital (Drs Bitton and Frolkis), and Department of Health Care Policy, Harvard Medical School (Dr Bitton), Boston, Massachusetts.

Arch Intern Med. 2011;171(19):1757-1758. doi:10.1001/archinternmed.2011.505

The decisive moment, it is the simultaneous recognition, in a fraction of a second, of the significance of an event as well as the precise organization of forms which gives that event its proper expression.—Henri Cartier-Bresson, The Decisive Moment

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.

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