Understanding how health systems facilitate primary care redesign

Abstract

Objective To understand how health systems are facilitating primary care redesign (PCR), examine the PCR initiatives taking place within systems, and identify barriers to this work. Study Setting A purposive sample of 24 health systems in 4 states. Study Design Data were systematically reviewed to identify how system leaders define and implement initiatives to redesign primary care delivery and identify challenges. Researchers applied codes which were based on the theoretical PCR literature and created new codes to capture emerging themes. Investigators analyzed coded data then produced and applied a thematic analysis to examine how health systems facilitate PCR. Data Collection Semi‐structured telephone interviews with 162 system executives and physician organization leaders from 24 systems. Principal Findings Leaders at all 24 health systems described initiatives to redesign the delivery of primary care, but many were in the early stages. Respondents described the use of centralized health system resources to facilitate PCR initiatives, such as regionalized care coordinators, and integrated electronic health records. Team‐based care, population management, and care coordination were the most commonly described initiatives to transform primary care delivery. Respondents most often cited improving efficiency and enhancing clinician job satisfaction, as motivating factors for team‐based care. Changes in payment and risk assumption as well as community needs were commonly cited motivators for population health management and care coordination. Return on investment and the slower than anticipated rate in moving from fee‐for‐service to value‐based payment were noted by multiple respondents as challenges health systems face in redesigning primary care. Conclusions Given their expanding role in health care and the potential to leverage resources, health systems are promising entities to promote the advancement of PCR. Systems demonstrate interest and engagement in this work but face significant challenges in getting to scale until payment models are in alignment with these efforts.

Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data

“…Thus, it is necessary to prepare a framework for primary care and link it to the provision of social services. This will facilitate visits of people with functional limitations to health facilities [ 53 , 94 , 95 ] and reduce financial barriers to their access to healthcare by maintaining continuity, inclusiveness, and coordination for people with functional limitations [ 96 ].…”

How to facilitate the introduction of value‐based payment models?

“…using specific clinical protocols and pathways to ensure consistency in care delivery). 9 If the organisation has a decentralised management structure with greater autonomy at the local level, 10 the VBP project may require flexibility (i.e. local decision-making and experimentation with new care delivery models or technologies).…”

Characteristics Associated With Financial or Non-financial Barriers to Healthcare in a Universal Health Insurance System: A Longitudinal Analysis of Korea Health Panel Survey Data

“…A recent study on primary healthcare reforms in Canada found that having regular access to a doctor reduced the risk of unmet healthcare needs (26). Encouraging individuals to have a regular primary healthcare provider seems a good way to not only reduce the most prevalent non-financial barriers to healthcare (time and information barriers) through fostering telehealth services or healthcare providers' or social service providers' visits to patients (73,74), but also to lessen financial barriers through maintaining continuity, comprehensiveness, and coordination of care (75). If regular primary healthcare providers and social service providers combine to form a primary care provider network to cater to the healthcare needs of individuals in each area of a country, it would be possible for individuals to receive timely and adequate healthcare services when they need them.…”