"Market share is going to places that can meet patients' needs and do it more effectively," Lee says. He warns that physicians who "won't be able to get their act together to adopt a strategic framework will be less successful and lose market share to organizations that can."
Under their plan, a physician practice would divide patients into small groups reflective of differences of "core needs and circumstance," Porter and Lee write. A practice may refer some patients to other providers better equipped to meet particular needs.
As it is now, an absence of a "robust overall strategy" is one of the causes of primary care's problems, according to Porter and Lee.
"Thinking about primary care as a single service not only undermines value but also creates a trap that makes value improvement difficult, if not impossible. We will never solve the problem by trying to do primary care better," they write. "Instead, primary care must be redefined, deconstructing the work that goes on within those practices and rethinking how it is performed."
Examples of the team focus: integrated cancer teams that increasingly include both palliative care specialists and a psychiatrist to measure patient outcomes. Or, patients with end-stage renal disease may be referred to a dialysis team that provides primary as well as nephrology care.
As Porter and Lee envision a new primary care structure, they say care teams and delivery processes can be designed for each patient subgroup, with measurable outcomes. Such data measurement is woefully lacking under current primary care, they say.