The president of Partners Healthcare and a Harvard University economist contend that primary care in the U.S. needs to be restructured to improve physician business practices and provide more value for patients.Under this "subgroup management," primary care physicians would oversee improved coordination of care for greater efficiencies and clinical outcomes.
So say Thomas H. Lee, MD, network president of Partners Healthcare, and Michael E. Porter, PhD, the Bishop William Lawrence University Professor at the Harvard Business School, and director of The Institute for Strategy and Competitiveness, both in Boston, in a Health Affairs article this month. I spoke to both of them about their primary care challenge. (Erika Pabo, MD, MBA, a resident at Brigham and Women's Hospital in Boston, was a co-author.)
"If we're going to make primary care as effective as we want to, we have to start with a clear overreaching goal and try to restructure primary care," Porter says. "It starts with value and that's the true north compass. Primary care isn't really one thing. It's a lot of different things for a lot of different patients with very different needs."
"If we can segment the needs and take patients and group them into fairly straightforward categories, such as healthy adults, or someone with one or two chronic conditions or very disabled people, we can understand the needs of a defined group of patients, and change the nature of primary care," Porter adds.
The primary care framework isn't working now, they say. As Lee sees it, too many physicians are "stumbling down a road, not sure where they are trying to go, as opposed to a bunch of people effectively moving down a road." For doctors, it's a vital question: their livelihoods are at stake.