An Undervalued Secret to Primary Care Success

By Doron Schneider, MD, MBA, FACP, Vice President, Clinical Product and Provider Solutions, Tandigm Health

February 2025 – Reduced revenue associated with Version 28 (V28) for risk adjustment,¹ increased quality cut points to achieve Medicare Advantage MA Star ratings,² physician fee schedule cuts,³ burnout,⁴ medical inflation,⁵ and an increasingly ill population.⁶   What do all of these have in common?  These are but some of the pressures that primary care practices face as we begin the new year.

So, with this as context, I write this article to shine a light on a workforce that, if optimized, will help practices to continue to operate, and potentially even thrive, in the coming year.  This workforce is the hundreds of thousands of medical assistants (MAs) who work tirelessly alongside PCPs in the trenches and help keep our offices running.

At a time when there is a deficit of over 100,000 MAs in the country and when primary care is being asked to do more than ever, we need to reexamine the vital role that these team members play in enabling our success and commit to growing, nurturing and investing in their future.⁷

What does investment look like?   By educating, training and developing MAs, one would see a return on the investment through improved quality of care, patient experience and outcomes.   Besides a financial investment (for example, increasing the hourly wage from the average of $20 an hour), we must invest our time, attention and energy to develop this workforce to be better equipped for the transformations necessary to improve the health of the population⁸.

Ultimately, an investment in MAs translates into different activities in the process of care delivery.   There is a long list of potential ‘tasks’ that we could develop our MA’s to execute, helping to meet the demands of value-based care and population health management.⁹   For example, this includes:

• Managing campaigns (either automated or manual) to reach out to individuals who are attributed to the practice but have not engaged with it in the past year
• Performing pre-visit planning, either through chart review alone or assisted with AI technologies
• Closing quality gaps in the office as exemplified by performing diabetic retinal eye screenings, handing out FIT stool tests, placing orders for mammograms and beyond
• Performing medication reconciliation when rooming patients, while simultaneously screening for non-adherence.

It is not enough to train MAs to do activities such as these.  If we simply shift the work burden to them and don’t think holistically, we risk MA burnout, and retention will suffer.

So, what is needed?   Among other things, we need to create cultures where we treat MAs with respect, provide feedback and coaching to help them grow, share performance data with them on the metrics they directly impact; ask for their ideas on what’s gone well and how to improve, and listen humbly as we encourage them to share what they see and feel. Ultimately, we need our MAs to be connected to the practice; feel a sense of pride, purpose, and agency; and have continued learning and development opportunities.  And yes, when the practice does well, and there are quality or shared savings incentive dollars coming in, these should be distributed to them as well.¹⁰

It is true that we are in the middle of a technological revolution. AI, machine learning, GPT technologies, NLP and other new solutions are quickly becoming part of the team.¹¹  While we welcome these new teammates, we can’t forget the ones with both the heartbeat and the heart, the ones who feel and have empathy for patients, who share in the joys and sorrows of the day and who can make or break our success.   As the financial pressures on practices mount, practices will need to make choices about where every penny of revenue is allocated.  I argue that now is not the time to pull back on MAs.  It’s time to invest.

About the Author

Doron is a practicing internist with over 25 years of leadership experience in population health, value- based care, patient safety and healthcare quality.

At Abington Health, Doron was Chief Safety and Quality Officer and led the organization in performance excellence to multiple state and national awards. His efforts were recognized in driving such metrics as potentially preventable readmissions, and reduction of harm events such as inpatient falls, CAUTI and pressure ulcers. Understanding the sociotechnical nature of complex adaptive systems, Doron also led development and oversight of EMR based techniques such as optimal design of orders and order sets, development of interruptive/passive alerts and other clinical decision support tools.

More recently, at Tandigm Health (a value-based care enablement company), Doron held several executive roles including Vice President for Population Health and Clinical Strategy. Doron led multiple departments and had operational responsibility over the network engagement team that directly

supported a network of hundreds of PCPs, the quality team that was responsible for driving HEDIS/STARS performance, and the patient experience team that oversaw CAHPS performance. Additionally, Doron provided strategic direction and operational support for novel program development and implementation aimed at reducing the total cost of care.

Doron has extensive experience as a clinician-educator. He has built and executed national training programs in quality improvement for the American College of Physicians aimed at primary care physicians and health systems and has multiple peer reviewed publications. Doron has coached dozens of practices across the United States in quality improvement, team-based care and quadruple aim goals. He currently serves as the Deputy Editor for the journal Clinical Diabetes and the Section Lead for Quality Improvement with the goal of identifying and spreading improvement stories. Additionally, Doron lectures at the Jefferson School of Population Health on Complexity Science. Finally, having been a health reporter for WPVI (Channel 6 in Philadelphia), Doron brings expertise and experience communicating directly with, and educating the public.

An adaptive leader, Doron uses the principles of high reliability, implementation and complexity science, appreciative inquiry, and quality improvement tools and techniques (amongst others) to drive change. He is known for combining his knowledge of the science of improvement, facility with data/analytics, and understanding of clinical workflows, processes and culture to engage multidisciplinary stakeholders and catalyze improvement.

References

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• Centers for Medicare & Medicaid Services. (2024, October 10). 2025 Medicare Advantage and Part D Star Ratings [Fact sheet]
• Centers for Medicare & Medicaid Services. (2024, November 1). Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule (CMS-1807-F)
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• Centers for Disease Control and Prevention (CDC). (2024). Chronic disease prevalence in the US. Preventing Chronic Disease. Retrieved from https://www.cdc.gov/pcd/issues/2024/23_0267.htm
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• Nursing Process. (2024). Medical Assistant Salary By State – (Highest-to-Lowest Paying). Retrieved from https://www.nursingprocess.org/medical-assistant-salary.html
• Dill J, Morgan JC, Chuang E, Mingo C. Redesigning the Role of Medical Assistants in Primary Care: Challenges and Strategies During Implementation. Med Care Res Rev. 2021 Jun;78(3):240-250
• Perlo, J., Balik, B., Swensen, S., Kabcenell, A., Landsman, J., & Feeley, D. (2017). IHI framework for improving joy in work. Institute for Healthcare Improvement. https://www.ihi.org/resources/white-papers/ihi-framework-improving-joy-work
• Sfarra, S. (2023). Transforming primary health care: The generative AI revolution. Medical Economics. https://www.medicaleconomics.com/view/transforming-primary-health-care-the-generative-ai-revolution