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Examining the resurgence of primary care


For too long, the nation's health care system has been out of balance. We have lost our focus on prevention and health promotion and spend most of our time and money focused on treating disease.

Editor’s Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, who is also past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


Glen Stream, MD, FAAFP, MBIFor too long, the nation's healthcare system has been out of balance.  We have lost our focus on prevention and health promotion and spend most of our time and money focused on treating disease.  We all know the statistics:  Despite healthcare system spending that surpasses all other countries, we rank near the bottom in terms of health.  It’s time to put the "health" back in "healthcare.” Evidence shows that a strong foundation of primary care is what our system needs to deliver on the Triple Aim of better health, better care and lower costs. 

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Currently, I chair the board of a collaborative effort among the eight leading family medicine organizations in this country.  Family Medicine for America's Health (fmahealth.org) is aimed at strengthening our primary care infrastructure in this country and-through Health is Primary (healthisprimary.org), our communications campaign-advocating for the values of family medicine and primary care.  We believe, and evidence supports, that health improves when patients have access to continuous, comprehensive primary care. 

Lost in translation: The physician-caregiver relationship

I have spent the last year visiting communities across the United States.  In these travels, I have seen firsthand the power of primary care and its impact on individuals and communities. During visits to Seattle; Raleigh, N.C.; Chicago; Denver and Detroit, I met physicians and their care teams, patients, payers and purchasers and heard their stories of transformation.  In places where teams are delivering true primary care I have seen evidence of happier, healthier patients and real cost savings for payers and purchasers.

Here are just a few of the trends that are emerging...

Next: Examining the trends


Health Care Under One Roof

During the Raleigh, N.C. stop, a representative from Carolina Advanced Health explained how UNC Health Care and Blue Cross & Blue Shield of North Carolina partnered to create the new joint-venture primary care clinic shortly following the enactment of the ACA.  The practice specializes treating adults with chronic medical conditions. 

The clinic provides patients with onsite access to comprehensive primary care, including tele-health specialty consultations, nutritionists, pharmacy consultations and mental health support.

Why are we wasting money on healthcare with poor outcomes?

This combination of team and technology has streamlined the medical process and improved patient care, while reducing costs. The model has reduced referrals and the need for patients to take days off from work to see multiple doctors and, by consolidating care both in terms of time and place, has made true coordinated care a reality.  

Group Visits for Patients with Chronic Diseases

In the Northwest, Devin Sawyer, M.D., director of the Family Medicine Residency program at Providence St. Peter Hospital in Olympia, Wash., has been using "mini-group visits" (usually three patients per group) in his clinic to help patients with diabetes support each other through treatment. These sessions include discussions of lifestyle changes, behavior changes and self-management to help control the disease.

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Patients in the groups benefit from the support of their peers dealing with the same condition and they regularly hold each other accountable for treatment, checking in with each other outside the office visits.

Next: Improving patient satisfaction and health outcomes


Clinicians are seeing impressive results when patients are seen in groups. Patients who participated in planned care and group visits saw lower blood sugars that they maintained over time and lower cholesterol readings, as well. Group visit patients also are twice as likely to engage in self-management and goal-setting than patients seen individually.

Individual Health Coaches in Primary Care

Finally, patients can feel disconnected from their physicians and unmotivated to participate in their own well-being. Iora Health and Humana recognized this challenge and partnered to open Iora Primary Care, a practice in Seattle dedicated to serving senior citizens.

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The model includes one-on-one health coaching as a way to emphasize preventive care for seniors and establish a dedicated advocate, confidant and friend for patients. As a result, patients are receiving personalized, comprehensive care and developing strong relationships with their care team. And while this model is just getting started, Iora's extraordinary patient satisfaction rates and outcomes data are providing significant momentum for its approach.  

Primary care practices around the country are innovating in care delivery in order to improve patient satisfaction and health outcomes while reducing costs.  Strengthening our primary care infrastructure-to ensure that everyone has access to comprehensive, continuous, quality care-will help make America healthier.  Together, we can MakeHealthPrimary.

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