Primary Care Builds Foundation for Coordinated Systems

Primary care is one of the top most strategic service lines in the next two to five years, according to HealthLeaders Media's Intelligence Unit. In this feature, Council members detail how they have improved the quality and coordination of care with primary care at the foundation of their provider systems.

How does primary care fit into your organization's overall service line strategy and what are the main goals for your primary care service line?

Xavier Sevilla, MD
Vice President of Clinical Quality for Physician Services
Catholic Health Initiatives
Englewood, CO

On the healthcare landscape: We are focusing on clinical integration, to align physicians and hospitals to deliver coordinated, high-quality care. The foundation of this new care delivery system is primary care. There is overwhelming evidence that a high-performance primary care service line is critical in achieving the triple aim of improving the health of populations, improving the experience of care of our patients, and decreasing per capita healthcare costs. We firmly believe that our primary care service line will be the key to our future success in this new world and at the same time help us achieve our mission of creating healthy communities.

On the role of primary care: There needs to be total transformation in the way that we operate our primary care service line. In April we started a large initiative in our health system to transform our primary care offices across the enterprise into patient-centered medical homes. This involves implementing several high-leverage changes such as team-based care, enhanced access, practice-based population management, improved care coordination, and patient-centered care.

On the added benefits: We believe that by implementing high-performance primary care offices we will also improve the morale and job satisfaction of our primary care physicians and staff. Our goal of transforming primary care will allow us to build a health system that will deliver affordable, coordinated, and high-quality care for all our patients.

William B. Riley Jr., MD
Chief Medical Officer, Administration
Memorial Hermann Sugar Land (Texas) Hospital
Memorial Hermann Katy (Texas) Hospital

Primary care is at the top of our list throughout the system because we are into the accountable care organization and medical home business, and you have to have sound primary care base to do that. So, that is a central core of our system strategy going forward for the foreseeable future.

We've got a number of medical homes within the system that are already up and running. The ACO application has been approved so we are going full steam ahead with this, and our primary care recruiting strategy has been in full gear for well over two years now. We are about as far along as you can get.

Recruiting problems with primary care physicians haven't really happened to us yet. We expect that it will and I think we are going to have to look to the use of mid-levels, advanced practice nurses, and others going forward. The big iceberg is when the floodgates are opened by the Affordable Care Act: How many people are going to show up expecting primary care doctors? From what I have been able to read and hear, there is going to be an unmet demand for primary care. That demand will very likely have to be filled by others, notably mid-levels.

Ninfa Saunders
President and CEO
Central Georgia Health System
Macon, GA

Primary care is going to be a very critical and pivotal service line for us. As we begin to look at care coordination, the physician in the middle is the primary care physician. Getting the manpower together is very important. To that end, the Medical Center of Central Georgia and the Central Georgia Health System continue to look at connections in primary care and strengthening that.

We just developed a model in a medical mall. There are three primary care physicians surrounded by rotating specialties. They have in the building a diagnostic arm for both radiology and laboratory to ensure that the care is coordinated within that particular clinic, driven and coordinated by the primary care physician.

We have a partnership with Mercer University. We are the teaching hospital. Mercer University's mission is to prepare primary care physicians in the region, with particular focus on underserved areas. Embedded in our partnership with Mercer as a teaching hospital is the ability to train and develop a strong primary care base so we will have the connection that feeds into the specialty base, not only for care but also to prepare these medical students for the future.

Scott D. Hayworth, MD
President and CEO
Mount Kisco (N.Y.) Medical Group

I run a 300-physician multispecialty group. About 50% of our physicians are primary care and 50% specialty, depending upon where you put OB-GYNs. As you look at the Affordable Care Act and healthcare reform and the move to value, there is a real shift to primary care in the country. As a result, all organizations are trying to expand their capacity in primary care. That includes using physicians as well as mid-level providers, physicians' assistants, and nurse practitioners.

We all have to expand our capacity to handle the volume. Unfortunately there is a real shortage of primary care physicians in the country. It is much easier for us to recruit primary care physicians than if we were a one- or two-doctor practice. However, there is such a severe shortage that even a large group like ours has trouble. To recruit them, we offer higher salaries and recruiting bonuses. They know they're more valued now because they have so much more opportunity.

Under the world of value, five years from now you are going to need more and more primary care doctors to keep your specialists busy. Because as we drive down procedures, specialists will need more doctors to feed them. In order to keep our specialists busy we are going to need more primary care doctors to feed them.