Does Primary Care Need To Be Retooled?

Joe Cantlupe, for HealthLeaders Media , March 14, 2013

"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.

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1 comments on "Does Primary Care Need To Be Retooled?"

George Anstadt MD FACOEM FACPM (3/14/2013 at 9:37 PM)
The Lee /Potter proposal: subjugate primary care physicians, and the patient's interests that the primary guards, using "market share" mechanism coupled with a "Strategic Frameworks" panacea; specialists and the system know best, or will know best as soon as Lee can assign someone the task of value guru. Further fractionate and specialize. The system with the most specialist wins. The patient centered notion is wrongheaded. In fact, as you look for value in the real world, the nations with the highest ratios of primary to specialty care are the best. For example, it is widely recognized that the US does 10x greater spine surgery than other nations, without any observed benefit in terms of spine health, but at far greater cost. No health status benefit / very high spine surgeon incomes + hospital charges + device prices = poor value. Lee contends that no one in his system is focused on health care value; yet, the primary is trained to provide value, which is best achieved by preventing disease in the first place, and also by finding simple solutions rather than tertiary care for problems. The US healthcare system impedes good primary care, especially prevention, with both financial disincentives and procedural barriers; never-the-less, if Dr. Lee were to examine the outcomes of his primary care doctors at the individual physician level, he would find a dedicated and caring minority who still do the right things, despite the difficulties, and as a result are getting much better health status outcomes, e.g. fewer MI, less new onset diabetes, etc., which save our healthcare system huge amounts of money. These are the overlooked folks in his system who are trained to provide value, and who ARE providing value. He should identify them, celebrate the increased health and decreased cost (value) that they are providing to our healthcare system, reward them financially, and learn from them. Their best practices should be facilitated with administrative and technology investments, and then shared them with the other primary care providers, which will not be a hard sell. Most of these primary care docs are longing to do these right things, but need encouragement, tools, time and financial incentives. Trouble is, insurance doesn't reward value, only encounters and procedures. So, Lee will have to figure out how to get paid for value, or just keep hiring more guys who do high revenue procedures, and push his primary care docs to encounter more people per hour. Our medical students are watching. Do we want more spine specialists and even fewer primary care docs?




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