Table 2.

The Impact of Focused Improvement Initiatives

	Panel Size	Access	Burnout	Primary Care Spending
Care management	Care management does not change panel size but care managers (RNs, pharmacists, or behaviorists) assist clinicians in a major way to care for their panels.	Patient visits to care managers can add capacity and thereby improve access.	VHA physicians performing care management functions without help from a team is associated with increased burnout while RN care management eases the burden of burnout.¹²	Medicare care management codes require too much documentation and too much time spent for inadequate payment.¹³ Overall, reimbursement for additional personnel needed to perform care management is either absent or insufficient.
Open access		A systematic review found that average wait times drop. Elderly patients may be lost to follow-up.¹⁴ Access gains may be lost over time if practice realities cause capacity to decline.¹⁴
Telehealth		It is unclear whether telehealth adds primary care capacity. Telephone and video visits including documentation may or may not be shorter than face-to-face encounters.¹⁵	Because virtual visits may have fewer staff involved, more responsibility rests on clinicians.	Clinicians worry that telehealth will reduce primary care revenue.¹⁶