It's time to optimize primary care for a healthier population

December 3, 2010

What specialty in medicine compromises the quality of its work based on its model of care? The author of this article points to primary care.

We know that primary care is important to the health of any population. We know that a rational healthcare system has a strong foundation of primary care. We know that primary care done well provides value by controlling healthcare costs while delivering services focused on the whole patient.

The current primary care practice model of a busy office schedule and fee-for-service visits is a recipe for burn-out and only a small percentage of new medical school graduates are choosing this line of work. I do not blame them. It is time to reinvent the work model of primary care. It is time to optimize the experience of primary care for the patient, the physician, and the staff and achieve a healthier population. New models exist to show that primary care can be radically changed to achieve these goals in a successful business model. I call this optimal primary care for the information age.

Optimal primary care would mean:

I know this scenario may sound pie-in-the-sky to most primary care physicians. But optimal primary care-or something close to it-already is happening in many progressive healthcare settings in the United States, by intentional design and by keeping an eye on continual improvement. Optimal primary care is being developed in large health systems like Group Health Cooperative in the Pacific Northwest, in medium-sized practices like GreenField Health in Portland, and where I work at Eisenhower Medical Center in Southern California, and in small practices such as the Ideal Medical Practice network developed by L. Gordon Moore, MD, from Rochester, New York. There's no running on the treadmill in constant hurry mode for these primary care physicians.

The May 2010 issue of Health Affairs devoted 47 articles to the theme of reinventing primary care. The focus was on the need for major change in primary care to save it and improve the health of Americans. Detail on many of the practices I mention above is there. From this effort, I see 2 general models emerging for optimizing primary care that I will discuss in this article. These are not mutually exclusive and many practices will have elements of both.

The Patient-Centered Medical Home (PCMH) has emerged as a general descriptor for improved primary care. The essence of PCMH is providing care coordination by a team that goes beyond patient visits to improve outcomes. I strongly support the PCMH movement but believe that optimizing primary care goes beyond the current descriptions of PCMH. Most PCMH models have added care coordinators, information systems, and teamwork for improved care, but many do not address the overall work model for the primary care physician who is still trying to see too many patients.

Two emerging models for optimizing primary care are what I call the Relationship-Centered Model and the Organized Team Model. They are best used for different populations and with different available resources.