Primary care is the foundation of high performing health systems, and when more people have better access to good primary care, those people are more likely to achieve good health outcomes, less likely to end up in the hospital or emergency room, and health care costs are lower. So it seems that policy makers are keen on the idea of supporting primary care. Yay.Good primary care has four cardinal features: good access to care, a relationship over time, comprehensive services, and care coordination. This makes primary care different from the rest of health care. Doing a good job on these cardinal features results in the good outcomes listed above. Doing poorly on these translates to worse outcomes and increased costs.
So how can we get some more of that good old primary care?
The solution is pretty simple. If you ask Rob Reid MD who with colleagues published the paper on the Group Health Cooperative PCMH work @ their Factoria practice, you'll find out that some simple interventions lead to profound results:
- Reduce the panel size and stop fee-for-service productivity incentives to help the practice unit get off the hamster wheel
- Add some incremental staff to support the extra work of care coordination, outreach to patients, etc
- Provide a small amount of training on process improvement
- Let the professionalism of the staff drive the work
This work can be replicated in practices large and small across the U.S. All it takes is a little bit of breathing room. Group Health has breathing room because it has its own insurance product and can call its own shots. GH is not beholden to hospitals looking to keep beds & emergency rooms filled. Finally, they chose to support excellence in primary care. The early results in publication look good. I expect continued and improved excellence and outcomes.
The part I like best about the GH Factoria experiment is the degree to which they replicate the work of the Ideal Medical Practices project in which volunteer practices got off the hamster wheel by reducing their own overhead and panel size. From a huge integrated system to solo independent practices. There's a lesson here.