Across the divide: “Primary care departments working together to redesign care to achieve the Triple Aim”

Abstract

Background Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim. Methods As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care. This article describes the process of aligning these three primary care departments: defining panel size, developing a common primary care job description, redesigning the primary care compensation plan, redesigning the care model, and developing standardized staffing. Results Prior to the initiative, the rate of patient satisfaction was 85%, anticoagulation measurement 65%, pneumococcal vaccination 85%, breast cancer screening 79%, and colorectal cancer screening 69%. These rates all improved to 87%, 75%, 88%, 80%, and 80% respectively. Themes around key challenges to departmental integration are identified: (1) implementing effective communication strategies; (2) addressing specialty differences in primary care delivery; (3) working within resource limitations; and (4) developing long-term sustainability. Conclusions Primary care in this large academic health center was transformed through developing a united primary care leadership team that bridged individual departments to create and adopt a common vision and solutions to shared problems. Our collaboration has achieved improvements across patient satisfaction, clinical safety metrics, and publicly-reported preventive care outcomes. Implications The description of this experience may be useful for other academic health centers or other non-integrated delivery systems undertaking primary care practice transformation.

Role definition is key—Rapid qualitative ethnography findings from a team‐based primary care transformation

“…Primary care redesign has been increasingly evaluated but has yet to be thoroughly explored from an implementation science perspective. This study takes a novel implementation science perspective and in so doing highlights a key lesson: Practice redesign can redistribute responsibility and patient connection throughout a team, but success of a team‐based model might depend on clear role definition.…”

“…As a complex system, it deserves an evaluation approach that is flexible and nuanced and targets the right outcomes at the right time (eg, acceptability and adoption as outcomes in early implementation phase). 7 Primary care redesign has been increasingly evaluated 19 but has yet to be thoroughly explored from an implementation science perspective. This study takes a novel implementation science perspective and in so doing highlights a key lesson: Practice redesign can redistribute responsibility and patient connection throughout a team, but success of a team-based model might depend on clear role definition.…”

A Simple Framework for Weighting Panels Across Primary Care Disciplines: Findings From a Large US Multidisciplinary Group Practice

“…Organizationally, this panel adjustment plan was clear enough to use in determining compensation, opening and closing panels, and making physician hiring decisions. Weighted panel sizes are also organizationally used for making staffing decisions, setting compensation, 22 , 23 building registries for chronic disease (eg, diabetes), and outreach to patients, all critical components of a high-performing primary care system.…”

“…We only considered established physicians who were present before and after the panel weighting was implemented. 22 We also compared the number of physicians with open panels. An “open panel” is defined as the ability to accept new patients.…”

Bridging Healthcare and Health IT

“…Physician training on the EHR (electronic health record) is now included, but baby boomer generation physicians will need additional training; the migrating physician license recertification to a computer based testing model is one way to help baby boomer become more comfortable with IT [9]. Physicians who enter an ACO are more likely to adopt IT, but the healthcare workforce requires training in health IT [10]. As strategies for improvements are increasing more measures and Health IT standards are being considered as met quality is shown through data, adapting to Health IT is a must for physicians as it is part of healthcare and is increasingly becoming part of the healthcare landscape as it drives analysis and meets the Triple Aim [11].…”