Care Redesign
Clip
Primary Care Providers as Whole Care Coordinators (05:10)

Is it possible to bring primary care back to the center of modern-day health care?

We should rethink that question, says Sara Singer, and put patients at the center. The primary care clinician is critical to ensuring that patients receive the care they need. But patients need someone knowledgeable about all the care they receive, over time, both in the doctor’s office and at home — and that someone should not just be the primary care doctor. Everyone who interacts with and on behalf of that patient should be involved, explains Singer. “I wouldn’t think of it as putting primary care, clinician, or specialist clinician at the forefront,” she says. “It’s really the patient we need to have there. We need to think about teams that function around those patients.”

“I would love the primary care role to really be in that coordinator’s role so that our patients and their families don’t have to be,” adds Care Redesign Lead Advisor Amy Compton-Phillips, noting that primary care is ideally suited to orchestrating all the pieces, particularly comorbidities.

Singer agrees — but with a note of caution. A primary care doctor or specific care coordinator in their office could play that role, she says, particularly for translational help with the more technical aspects of care. But patients or family members of those patients may also want to be the coordinator. We also need more experimentation to determine how this role will work before we create a final model.

From a specialist standpoint, the primary care clinician is crucial to overseeing comorbidity and polypharmacy, adds Bastiaan Bloem. His Dutch ParkinsonNet has staff trained in over 12 disciplines. Primary care is not one of them, but it still plays an important role. Bloem stresses that patients should never receive care from a specialist alone. “A specialist on an island is a threat to health care,” he says.

“I foresee a future where we have funnels of knowledge where there are networks dedicated around specific diseases, where networks function dedicated to that particular condition, but there is an overlaying layer of primary care physicians — and the ultimate generalist is the patient,” says Bloem. “He or she works together with the primary care physician. They oversee comorbidity, polypharmacy, and exploit these expert networks when needed.”

From the NEJM Catalyst event Care Redesign: Creating the Future of Care Delivery at Kaiser Permanente Center for Total Health, September 30, 2015.

More From Care Redesign
Community Resource Referral Type

Assessing and Addressing Social Needs in Primary Care

Lincoln Community Health Center improved care quality by measuring and responding to upstream social and economic risk factors disproportionately affecting low-income households.

Time Driven Activity Based Costing for ECMO

Achieving Value in Highly Complex Acute Care: Lessons from the Delivery of Extra Corporeal Life Support

To improve both the value and outcomes of ECLS, Cedars-Sinai Medical Center created guidelines for ECLS delivery and explored opportunities for more efficient care.

ARISE and SFHN BHVS Collaboration

The “Behavioral Health Vital Signs” Initiative

A safety net system’s trauma-informed approach to integrating interpersonal violence into behavioral health programs in primary care.

OpenNotes Epic Patient Email Cascade Chart February 1, 2018 - August 14, 2018

Measuring Performance of OpenNotes Initiatives to Target Improvement Efforts

How a New York safety-net health system used data science to identify obstacles to OpenNotes use, address technical barriers, and develop strategies for improving clinical note sharing by providers and viewing by patients.

Mapping a Technology Strategy for Bundled Payment Care Using a Value-Driven Framework

Harnessing Emerging Information Technology for Bundled Payment Care Using a Value-Driven Framework

A four-part framework developed by physicians at Partners HealthCare provides a stepwise process for assessing and integrating technologies to effectively use data through a continuous patient experience.

UCLA Health CKD Risk Stratification and Management

Proactively Catching the Declining Patient

A coordinated effort by UCLA leaders to identify a high-cost population with chronic kidney disease and to modify care processes and personnel has led to improved health and reduced utilization.

Telehealth and remote monitoring are little used and ineffective for chronic disease care

Survey Snapshot: Treating Chronic Disease Proactively

Though survey respondents don’t indicate strong use of telehealth and remote monitoring, NEJM Catalyst Insights Council members discuss the ways they’re using these tools to monitor chronic disease, with good results.

Platforming Health Care Operations - Consumer-Driven Health Care - Business-Minded Optimizations

Platforming Health Care to Transform Care Delivery

Health care leaders need to focus less on ownership and control of the delivery process, and more on outcomes, cost efficiency, and customer experience.

Shah05_ integrated systems innovation pullquote

Build vs. Buy: What Should Health Systems Do?

The consolidation craze continues, but vertical integration has yet to demonstrate real progress toward the Triple Aim. Health care leaders would do well to consider innovative approaches that are working in other industries, including the tech-enabled full stack model.

Diagram Illustrating the COPD Care Pathway at Allegheny General Hospital

End-to-End Care for COPD Patients that Improves Outcomes and Lowers Costs

Allegheny General Hospital created a comprehensive solution for patients with chronic obstructive pulmonary disease (COPD) that led to improved clinical outcomes, reduced hospital admissions and readmissions, and a resultant decrease in the total cost of care.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Design Thinking

20 Articles

Taxonomy of the Patient Voice

While health care pursues the important trend of putting patients at the center of care,…

Differences in Ambulatory EHR Use Patterns…

UCSF Health found that women providers spent more time in the EHR and documented longer…

Proactively Catching the Declining Patient

A coordinated effort by UCLA leaders to identify a high-cost population with chronic kidney disease…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now