The Coming Primary Care Revolution

Abstract

The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. Rising healthcare costs, high rates of waste, the continued trend towards chronic non-communicable disease, and the growth of new market entrants that compete with primary care services have set the stage for fundamental change in all of healthcare, driven by a revolution in primary care. We believe that the coming primary care revolution ought to be guided by the following design principles: 1) Payment must adequately support primary care and reward value, including non-visit-based care. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an ever-increasing role in most aspects of healthcare. 3) Generalist physicians will increasingly focus on high-acuity and high-complexity presentations, and primary care teams will increasingly manage conditions that specialists managed in the past. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training.

Quality of primary care provided in community clinics in Japan

“…Numerous studies have shown that primary care contributes to improved population health, lower costs, and greater equity . Therefore, primary care plays an increasingly important role in the healthcare system as the population ages rapidly and becomes more diversified …”

“…Measuring and improving the quality of primary care are essential for ensuring high‐quality and efficient care; however, small medical facilities are often left out of quality improvement activities compared to large hospitals. The quality of primary care in small medical facilities has therefore drawn increasingly close attention …”

“…The quality of primary care in small medical facilities has therefore drawn increasingly close attention. 3 Quality indicators (QIs) have been widely used to evaluate and improve the quality of care in various healthcare settings. QIs are explicitly defined, and measurable items include structures, processes, or outcomes of care.…”

Analytics and Telehealth Emerging Technologies: The Path Forward for Smart Primary Care Environment

“…Accordingly, the primary care should be derived by key principals such as: (i) relationships to serve as the bedrock of value fostered by teams, improved clinical operations, and technology; (ii) patients and non-physicians engaged in most aspects of healthcare; and (iii) the whole-person care including health behaviors and social services [7]. In alignment with this vision, we propose the Smart Primary Care Environment (SPCE) as a health ecosystem of interacting objects, e.g.…”

Primary Care Physician Referral to Physical Therapy for Musculoskeletal Conditions, 2003–2014

“…2 With the development of new healthcare delivery and payment models and the increasing medical complexity of the primary care patient, PCPs are facing greater pressure to deliver coordinated, integrated, team-based care to achieve improved population health. 3 While physical therapists are sometimes mentioned in team-based models of primary care, little empirical data are available on the extent to which PCPs engage physical therapists in patient care. Current guidelines recommend physical therapy (PT) as an essential component of first-line treatment for many musculoskeletal conditions.…”