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Primary care is the "beleaguered," "underappreciated stepchild" of U.S. healthcare that's on a "mission impossible" as currently organized, but three prominent thought leaders believe they've created the recipe to change that.
Primary care is the "beleaguered," "underappreciated stepchild" of U.S. healthcare that's on a "mission impossible" as currently organized, but three prominent thought leaders believe they've created the recipe to change that.
Primary care's problems stem from the way most primary care practices are organized, according to a recent study in Health Affairs. Specifically, today's primary care practices "attempt to meet the disparate needs of heterogenous patients with a 'one-size-fits-all' approach," the study says.
Primary care practices generally have no organizing principle beyond increasing the volume of services for which they can be reimbursed, according to study authors Michael Porter, MBA, PhD, a Harvard business professor; Erika Pabo, MD, MBA, a clinical fellow at Harvard Medical School; and Thomas Lee, MD, MSc, network president at Partners HealthCare in Boston.
Unless primary care is redefined and organized in a different way-one in which it can "deliver and demonstrate measured value"-the field will remain marginalized, according to the study.
"We believe that most healthcare organizations currently operate without an overall strategy for improving primary care," the authors write. "Consequently, the hard work of clinicians is dissipated because of a lack of clarity about what they are trying to accomplish, and for whom."
The key to redefining primary care lies in shifting it to what the authors call "value-based patient subgroup management." Fair enough, but what does that mean?
The authors list the following "five essential elements" of this management approach.
Although creating care coordination teams and dividing patients in subgroups may sound like a lot for the average primary care practice to handle, the authors stress that these changes aren't "radical." Several organizations-including Commonwealth Care Alliance, CareMore, Intermountain Healthcare, and the U.S. Department of Veterans Affairs-already have implemented some elements of the value-based model of primary care, according to the study.
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