Innovating locally, transforming nationally

Just in time for the unofficial arrival of spring in Washington, D.C., ACHP and Kaiser Permanente convened a group of health care experts and physicians for an interactive panel on the future of primary care. As moderator Kavita Patel, M.D., managing director for Clinical Transformation and Delivery at the Brookings Institution, stated in her introduction, the Kaiser Permanente Center for Total Health was a particularly auspicious venue for such an event, as its bright interior reflects a culture of health, happiness and pride.

ACHP’s President and CEO Patricia Smith kicked off the discussion by recounting the efforts undertaken by 17 ACHP member organizations to improve health care by transforming the current primary care system, detailed in ACHP’s Strengthening Primary Care for Patients report. Smith noted that these strategies include partnering with practices to provide infrastructure grants to support investments in health information technology; convening practice collaboratives to spread innovations and best practices; engaging consultants to facilitate provider-led change; and developing new payment and reimbursement models that reward comprehensive care.

ACHP plans’ efforts to transform primary care have led to some impressive results, she continued, such as increased patient confidence in their ability to manage and control their health; increased patient and provider satisfaction; shorter wait time for appointments; and reduced hospital admissions and readmissions.

Michael Cropp, M.D., president and CEO of Independent Health in Buffalo, N.Y., then discussed the four key elements of successful primary care practices: access, reliability, interaction and vitality. Dr. Cropp reported that the dynamic at Independent Health changed radically once patients were literally brought to the table to discuss how to redesign primary care. This dialogue with patients facilitates getting all parties – patients, primary care physicians and specialists – to work as a collective team. In addition, physicians in Buffalo can now “control what happens downstream,” meaning that by increasing primary care spending 2 percent, practices have been able to reduce a full 10 percent of total plan spending through avoiding unnecessary urgent and chronic situations.

Scott Smith, M.D., associate medical director of operations at Kaiser Permanente in Colorado, delved into a discussion of continuity-based care, an approach initiated several years ago after patients’ first-hand perspectives were incorporated into Kaiser Permanente’s primary care system. Patients emphasized the importance of stability, responding that they wanted appointments with the same physician. After this feedback was integrated, there was a significant jump in the rate at which patients consistently saw their primary care physician: in 2006, only 54 percent of patients experienced continuity, while in 2012 the figure stood at 83 percent. Stated Dr. Smith, “We wanted to bring the best of what makes a small practice works, and put it together with the best of a large practice.” By incorporating other practice redesign elements, such as scheduled phone consultations with patients and proactive outreach efforts for preventive care, the practices engendered trust and improved patient access to care. As Smith affirmed, patients love the results, and physicians are seeing exceptionally high levels of patient satisfaction.

Concluding the panelist presentations was Marci Nielsen, chief executive officer of the Patient-Centered Primary Care Collaborative, who spoke of the need to transition the fee-for-service system into one in which risk and reward are shared by payers and providers. Nielsen argued that though the patient-centered medical home model may be necessary, it is insufficient: We still have not fully brought patients to the table. The critical element of public engagement is still missing in the movement, and we must not only engage patients, but also the rest of the system, in the medical neighborhood – hospitals, specialists, primary care providers and the public health sector are all partners in this transformation. “We have won the election,” she declared, meaning that people see the appeal of the medical home model and primary care redesign, but now these concepts must be fully executed. Joining in the effort are the federal and state governments; there are currently 41 state Medicaid agencies that are implementing patient-centered medical homes in some capacity. However, what works in one community may not work in another, a prescient reminder that Nielsen highlighted when she asserted, “If we’ve learned anything from this journey, it’s that one size doesn’t fit all.”

The subsequent question-and-answer period allowed the panelists to describe in further detail their organizations’ efforts to build relationships and trust with patients and providers, improve quality metrics to reflect what “really matters” to patient health and manage work force issues in light of a primary care work force shortage. Based on the ensuing dialogue and the perspectives of both panelists and participants, it is apparent that we are in the era of implementation, when it is more imperative than ever to keep in mind that patients should be at the center of reform. As Kavita Patel appropriately concluded at the close of the session, “Thinking and planning is one thing, doing something is another. And we’re in the do phase.”

Photos 1, 3 and 5 courtesy of Kaiser Permanente – see more photos of the event here.

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