No one in the health care field really wanted to “reinvent” primary care. But rising health care costs, elimination of the preexisting condition clauses, and expanded health care coverage forced a closer look at health care spending. And the cost of uncoordinated care – particularly among consumers with comorbid health/behavioral health conditions – has focused payers on moving primary care to more “integrated” models. But, making integration of primary care and behavioral health work is a challenge. Reimbursement, delivery models, cultural differences, and sustainability are all strategic issues for consideration.
For primary care professionals, both this broader range of issues, as well as participating on team-based care, is a challenge. For executives of specialist organizations, how to be part of the primary care systems and whether to expand and offer primary care services are key strategic issues.
At next week’s 2016 OPEN MINDS Executive Leadership Retreat, we’ll take a hard look at the emerging leadership issues posed by this fundamental shift in the role of primary care in the field. Leading off the first day of the retreat is an executive who is forging a common vision and mission for primary care and behavioral health, and is working through the organizational challenges of that mission – Peter Anderson, M.D., president of Team Care Medicine and co-author of the book, Lost and Found: A Consumer’s Guide to Healthcare. In his opening keynote, “Reclaiming The Primary Care Consumer Experience & What It Means To Health & Human Service Organizations” he will discuss how to optimize the consumer experience in an integrated setting, and highlight where innovation is most needed.
After the advent of managed care and the integration of an electronic health record (EHR), Dr. Anderson found himself running his family practice in the red despite working long hours, and subsequently “hating the practice of medicine.” The responsibility of maintaining health in an aging patient panel along with these new administrative and documentation requirements were overwhelming. By making some simple yet meaningful changes in his exam room process and elevating the role of his nurses, he saved his practice and went on to found Team Care Medicine (TCM), a practice transformation consulting firm.
I had a chance to catch up with Dr. Anderson about his work – and his perspectives on how leaders today can meet this challenge. He had some great tips for other executives.
In what way do health care professionals have to think differently today?
Dr. Anderson noted that the solution for many of the challenges facing practices is not a need for more money, but to forge a common vision and mission, and persistently work through the organizational challenges that will arise repeatedly, and often.
Only two to three decades ago, primary care doctors had independent, cottage practices. Then HMOs came along and there was a collision between the doctor and administration. There was a big chasm between clinical medicine and the system, across which each said the other didn’t understand their needs. Both evangelized to the other. Practices became less productive, even less self-sustaining, and far less pleasurable. We needed to try to understand what the business side of the house needed in order to stay in business. But a lot of habits were deeply ingrained, and doctors were pretty resistant to change. Today, 70% to 80% of primary care doctors have an exit strategy because of the mounting pile of paperwork, legal costs, and the shrinking amount of face-to-face time with patients.
A common vision and mission between primary care doctors and administration – around the need for robust primary care that is both quality producing and financially self-sustaining – generates a new way of thinking and drives the persistence to work through the organizational challenges. As administration understands the need for enough “exam room skilled” clinical staff and as primary care physicians understand the need to adhere to accepted business norms, a primary care network can be transformed. Through persistence, I was able to entirely recreate my primary care office by developing a new delivery mechanism.
What does it take to “reinvent” change in primary care?
Dr. Anderson was adamant that there is good news for organizations looking to integrate, and that not only can primary care be “fixed”, but that the solution is ready now. The key, organizations need to combat the feeling that they can’t make these changes, which is creating a sense of apathy. He noted:
All of us want it “better”, and not just for financial reasons. The solution can be done now; results are possible for timely access, better quality, restored job satisfaction for staff and providers, healthy work/life balance, and turning down cost. Doctors need outside influence to help create the momentum to force the transformation. I don’t know if primary care has the internal will to make the change themselves, but the move towards value-based payments will force us to achieve better outcomes, and higher quality across many patients. No longer can we keep using the same traditional delivery process that has been the norm for the last 100 years.
One of biggest parts of what is missing is educating the public, informing them about what good evidence-based medicine looks like and how to navigate through our medical system. Things like a patient-centered medical home and a good doctor/patient relationship should be everyone’s home base for medical care. They need to learn to push the doctor to help them. Urgent care and the emergency department (ED) do not substitute for a good doctor/patient relationship.
We are also tech savvy now and a lot of medicine can now be done through telehealth, and through the virtual world – email for information dissemination, for example. But, the information still has to be interpreted by the primary care physician. That personal connection is still foundational for quality and cost effective care.
Today’s health and human services market requires a new leadership vision to help force the ongoing transformation to a new model of care. For more, stay tuned to our coverage next week at The 2016 OPEN MINDS Executive Leadership Retreat, where Dr. Anderson will present, “Reclaiming The Primary Care Consumer Experience& What It Means To Health & Human Service Organizations.” Look for our daily briefings, live from the event and follow our coverage on Twitter @openmindscircle – #OMleadership.