Integration and the role of primary care is a key issue across the health and human service field – whether you are a manager of a health plan, a health system, or a provider organization. From a policy perspective, we are moving to a system where primary care is the big bet for health improvement and cost containment, from patient-centered medical homes (PCMH), to health homes, to the comprehensive primary care initiative, to accountable care organizations (see Creating Patient-Centered Team-Based Primary Care, Reinventing Primary Care – A Challenge For All Health Care Executives, and Specialty Care & Primary Care Reinvented).
The federal Substance Abuse and Mental Health Services Administration (SAMSHA) is also betting big on the integration of primary care into mental health organizations (see What Has Been The Cost – & The Results – Of SAMHSA’s Primary Behavioral Health Care Integration (PBHCI) Program? and Evaluation Of The SAMHSA Primary & Behavioral Health Care Integration (PBHCI) Grant Program: Final Report).
My question is whether this focus on, and investment in, primary care will pay off. On paper, it sounds logical. But primary care isn’t exactly a stable foundation for a health policy platform. These headlines tell the story – 16% Of Physicians Hanging Up Their Spurs and Burnout Is Big. When I talk to executives of mental health organizations that have added primary care programs, most of them say that without grant money, the models will not be sustainable.
So what is the fix for primary care? According to the keynote speaker at our 2016 OPEN MINDS Executive Leadership Retreat, Peter Anderson, M.D., the solution is moving to a “team inside the exam room” in primary care. In his address, Reclaiming The Primary Care Consumer Experience & What It Means To Health & Human Service Organizations, he spoke of his personal experience as a primary care physician – long hours and red ink. But, he went on to develop a primary care delivery model that is focused on high-quality consumer care (his four “C’s” for better health outcomes are competent treatment, continuous care, cost effective services, and convenient access) and making money. His key was to redesign clinical processes with more staff to do all the non-physician work of the exam room typically done by primary care physicians. This “team” approach enables same-day appointments and increases financial viability of primary care. What are those functions?
- Initial medical data collection
- Presentation of data
- Scribing of entire visit
- Ordering of the physician’s treatment plan
- Control of the visit
- Closure of the visit
Dr. Anderson shared how these functions saved his own practice – from both a clinical satisfaction and financial perspective. And, he gave examples of the impact of applying team-based approaches on a group of eight internists – quarterly revenue rose by 42% – from $53,000 to $318,000.
It appears this “team” approach is also central to making primary care work in an integrated, value-based market. Dr. Anderson’s points on process are parallel to the comments of Dennis Freeman, Ph.D., chief executive officer for Cherokee Health Systems, at The 2016 OPEN MINDS California Management and Best Practices Institute – it’s all about reengineering the consumer interface and the clinical workflow process (see Integration Is All About The ‘Flow’). A system that can provide primary care services, as well as behavioral health visits, is a system that needs teamwork, great technology, real-time performance management, and leadership.
For more on the challenging evolution of primary care, check out these resources from the OPEN MINDS Industry Library:
- The Medical Home As Gateway To The Future Of Health Integration
- Reinventing Primary Care – A Challenge For All Health Care Executives
- How Do You Develop & Manage An Integrated Primary Behavioral Health Practice: Lessons Learned From Executives Who Are Making It Work
- Aligning Clinical Compensation For The New Value Equation
- The Health Integration Meeting: A Concrete Example Of Integration Between Behavioral Health & Primary Medical Care – Sponsored By Welligent
- To Hit The ‘Triple Aim’, You Need The ‘Quadruple Aim’
- ACO Primary/Care Integration Reduced Emergency Department Visits By 13%
- Creating Patient-Centered Team-Based Primary Care
- Leadership In Bridging The Primary Care Integration Divide – Advice From Meridian’s CEO, Hank Milius
- CMS Selects 14 Regions For All-Payer Comprehensive Primary Care Plus Demonstration
Make sure to tune in tomorrow for more coverage of The 2016 OPEN MINDS Executive Leadership Retreat. If you couldn’t join us in Gettysburg, be sure to check out our live coverage on Twitter @openmindscircle #OMLeadership, and look for photos of the retreat on our Facebook page.