Despite having some of the most advanced healthcare tools and highly-trained practitioners, the United States has one of the least efficient healthcare systems of all developed countries.
Over the years, I have come to realize that it’s not the development of devices or the medical prowess that makes the difference: it is the delivery of these services and the impact it creates on the population. Moreover, it is our delivery of care to patients which is often inefficient and ineffective, leaving our patients on the sidelines.
From the rising number of chronic conditions, claiming about seven out of 10 deaths in the U.S., to the ever-increasing cost of care— healthcare is plagued with challenges that beg for innovative solutions in every domain. Patients still have a hard time navigating from one care provider to another. The physicians spend approximately half their workday on electronic health record (EHR) systems, pulling together pieces of fragmented information. The rate of physician burnout is growing, and so is the number of medical errors- which is the third-leading cause of death in the United States.
Most of these issues stem from the nation’s primary care system. High-functioning primary care services are the core of robust healthcare systems. American adults with primary care physicians have 33% lower healthcare costs and a 19% decrease in the rate of death, compared to those who only see specialists.
We need a transformation: a moonshot. We need a defining moment to fulfill these grand visions of becoming an efficient healthcare system. Improvements in U.S. primary care have the potential to save $67 billion each year, but hardly any efforts have been made to strengthen the fundamental core of healthcare, primary care, and drive healthcare’s grand transformation.
Here’s how improving primary care can drive innovation in care delivery:
Become The Hub of Coordinated Care
Primary care physicians are a patient’s first point of contact in the healthcare network. Some people don’t realize the indispensable role of a primary care physician, but the primary care physician is the “trusted healer” and offers familiarity for the patient. Doctors understand the patient’s medical history and have a comprehensive view; this knowledge and familiarity help them to personalize care and save time.
If patients see the same doctor over the course of time, the physician is able to build a stronger relationship with the patient and a more comprehensive view of their needs. Synergies between the trusted healer and the patient are strongest when the patient is at the center of the healthcare continuum, and activities such as scheduling referrals, prescribing medications, and encouraging patient self-management, are coordinated with the patient’s needs in mind.
Build Trust with Patients and Engage Them
Nearly 6 out of every 10 minutes of a physician’s time with the patient is spent documenting information in the EHR, keying in details of medical examinations, diagnoses, and ICD codes. Physicians need to spend more time building relationships with patients. They need time to demonstrate expertise, empathy, and familiarity with prior medical history, as well as understanding health literacy levels and socio-economic factors impacting their patients’ health.
Additionally, focused communication with minimal distractions and interruptions is important. Primary care providers should offer their patients ample time to explain their situation and assist them in understanding the medical terms and plan for treatment. This has to be followed by regular communications, such as reminders of the next visit, and following up with patients.
Leverage Community Resources to Coordinate Care Beyond the Hospital
In the evolving healthcare world, patients end up receiving care across multiple venues, most of it beyond the four walls of the hospital or clinic. When doctors understand the socioeconomic risks and vulnerabilities their patients’ face, along with the clinical risks – they are in a position to effectively engage the community on behalf of the patient.
It’s important for any physician to know the entire ‘back-story’ of their patient before they make any decisions- what do they do for a living, where were they brought up, how educated they are. The social determinants of health make a significant chunk of non-clinical data that impacts a person’s health, and providers need to consider that. The success of any care plan can be hugely improved by considering the social determinants.
Plus, there are instances where the care team can’t directly get in touch with a patient. For example, a patient who has been discharged after knee surgery will be needing help with transportation. Or, a patient with chronic hypertension would require a healthy lifestyle And, when we can put community outreach tools in the hands of the care team – they are able to scale these programs and comprehensively address barriers to healthy living.
Giving care teams insights into the specific aspects of social risk such as unsafe living standards, lack of access to healthy foods, and information on patients’ health literacy can be instrumental for effectively engaging with patients. Once vulnerable patients are identified, the care teams need a framework to easily connect with community partners – ultimately it boils down bringing the health system and the community together on behalf of the patient.
Build Smarter Care Teams and Keep Physicians Engaged
There was a time when innovation in healthcare skirted around its digitization. Healthcare is now electronic, and even if it is still early in the journey or in primitive stages, there is no going back. Now, we need to transition from the point where providers have fragmented information about their patients to an ‘age of intelligence’ where integrated, actionable information is available at the point of care.
A key aspect of healthcare transformation is providing team-based care and putting the patient at the center of the care team. This team includes the doctor, care manager, extended care team members, and non-clinical members. These multi-disciplinary teams will be supported by powerful analytics and insights such as missed measures, dropped codes, screenings due, and are accessible to the team at the point of care. And as the core member of the care team, patients stay connected with their care teams as part of their day-to-day self-management.
This vision is not part of some far-off futuristic system of medicine. We have early adopters delivering this level of care today – and all the resources we need at our disposal for the larger system transformation. Indeed, we are at the dawn of this grand transformation today. Enhanced primary care is the nexus of this transformation, driving positive change and creating innovative solutions to free the healthcare system from the tyranny of the past.
Paul Grundy, MD, MPH, FACOEM, FACPM, known as the “godfather” of the Patient-Centered Medical Home movement and member of the Institute of Medicine, joined HealthTeamWorks from IBM. Prior, he was the Chief Medical Officer for IBM’s Healthcare and Life Sciences Industry where he developed and executed strategies on transformation initiatives in the healthcare industry. Paul currently serves as a director of the ACGME, the body responsible for accrediting graduate medical training programs. Paul is the founding President of the Patient-Centered Primary Care Collaborative, an organization dedicated to advancing a new primary-care model, called the patient-centered medical home; he was also fundamental in creating it in early 2006. Dr. Grundy sits on the Strategic Advisory Council at Innovaccer.
