Moving Towards Transformative Primary Care

By Dr. Chris Chen, CEO of ChenMed

The recently passed Inflation Reduction Act (IRA) includes provisions to cap out-of-pocket spending for Medicare patients and allow Medicare to negotiate for lower drug prices. Laudable as that is, America continues to address symptoms rather than causes. What we really need is foundational change, and that starts with committing to what I call transformative primary care.

Traditional primary care in the United States is narrow and reactive. Primary Care Providers (PCPs) are too often put on a treadmill by business administrators and they burn out. Success is measured by a fee-for-service (FFS) structure that rewards physicians based on the quantity of the services they provide, not on the quality of those services or the patients’ outcome. The result is too many patients, too little time, and PCPs not doing much of the work they are equipped to do that would transform health and well-being. This isn’t serving anyone. Costs rise and patients’ health worsens because they are missing the prevention and lifestyle support that would improve their health and reduce expensive, reactive care.

There is another model of primary care that could do far more than anything in the IRA legislation: transformative primary care. It requires PCPs to make a switch – one that they’ll probably look back and wish they made sooner. Transformative primary care requires leaving behind FFS. Instead, PCPs are paid per patient and take responsibility for all the care a patient needs. This leads to a holistic, proactive approach where care teams see patients more often as a way to build trust and change habits. Providing this style of healthcare leads to better management of chronic diseases and improved patient health.

In this structure, clinical management is key, so practices tend to be physician-led, which means better health outcomes are the priority. Doctors are rewarded because their patients have good results, not because they billed a lot of services.

It seems obvious that beneficial behaviors emerge in a “warranty-like,” full-service model versus a “mechanic-like,” FFS model, and that everyone would want healthier patients and lower costs. But, the status quo has powerful allies in the form of successful incumbents, and doctors worry about taking risks for costs they may not fully control.

However, primary care practices should take heart in the fact that there are tried and true steps to take to becoming transformational leaders. When you have the economics right, the big “T” of transformation comes from three small “t’s”: training, teams, and technology:

  • Training: If doctors don’t know how to lead teams and understand business, it is hard for them to drive change. Ideally topics such as leadership, influence, service orientation, and medical economics would be central to medical training. Until that happens, primary care practices need to have robust onboarding programs and continuous training to teach these skills and reward and value these qualities. Doctors are quick learners and will realize that they can apply these skills to any situation. Take the status quo where it is so often overlooked that prescribing patients a medication they can’t afford, even if it is the best one for their condition, isn’t responsible medicine. Transformative care understands that if doctors don’t acknowledge patients’ personal situations, they will never really be able to help them. This may mean adding non-medical services such as free rides to and from appointments or helping ensure access to healthy food.
  • Teams: If doctors don’t have a team that does more than office administration, rooming patients, and billing, it’s hard for them to truly manage a panel of patients. Roles like medical assistant or receptionist are narrow. Staff needs roles with defined purpose around care facilitation, coordination, and health promotion. They need to meet daily to collectively surface issues and opportunities.
  • Technology: If technology is a mechanism to standardize process, doctors can’t manage the health of a population with systems designed as billing workflow engines. Today, more and more systems pull together data from multiple sources – both clinical and social – and can deliver clinical decision support at the point-of-care. This is key to reinforce the best practices of transformative primary care.

Transformative primary care can be spurred on by many policy changes. But, make no mistake, it can be done today by anyone who wants to make the bold choice to do it. The benefits to patients are real. Transformative care is proven to lead to better patient outcomes. One network using this model has seen a 22% lower incidence of stroke for patients, 35% fewer emergency room visits, and a 51% lower incidence of hospitalizations. It has also seen happier employees because they can focus on what most people in the medical field want to do – help people be healthier and happier.

The editorial staff had no role in this post's creation.