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OptumCare and the challenge of redesigning primary care

By C. Todd Staub MD/FACP

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Primary care needs to continue to evolve as we build a better health care system that works for people.

At OptumCare®, we are working with clinical leaders and experts in redesigning primary care as the central foundation of an ambulatory, community-based delivery network — one that meets people where they are and brings health care to them. 

Accelerating the evolution of health care at scale is the great challenge facing all of us in medicine across the country. The key to the success of this evolution lies in primary care — the active ingredient for creating value, affordability, and for meeting the needs and expectations of people. 

In the last few decades, physicians have been creating higher functioning primary care practices, after more than a century of a static and antiquated model that looked much like the weaving of Irish sweaters on a loom in the back room. 

With the advent of the patient centered medical home, electronic health records, team based care, disease management programs, and forays into the realm of population health, waves of change have swept through the primary care world. But there are even greater changes coming.

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Waves of change ahead

As we continue to rethink primary care, there are some hard realities to face. Foremost is an ongoing primary care shortage involving physicians and advanced practice clinicians.

New care team models will need to leverage the training and expertise of providers to care for larger panels of patients, with work allocated based on the risk and severity of illness. Empowering and engaging patients in their own care will be a key part of this process.

Primary care physicians largely have left hospital practice and have pulled back from other venues care — nursing homes, rehabilitation facilities, schools and home care.  New models need to reconstruct these connectors and restore the continuity of care that people need and expect from health care. 

This next generation of primary care clinicians has their own, healthier ideas of work/life balance — and they can choose from multiple job offers. Our organizations must accommodate these expectations if we are going to grow.

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The training of the next generation of primary care clinicians requires a reset in the philosophic orientation of our medical schools and the addition of new schools, too, as we are witnessing in other large health care systems. 

Leaders in graduate medical education need to consider a shift of training from hospitals to advanced primary care settings in community practice if we are to train a workforce that can meet the needs of our national population.

And, by the way — a massive wave of new Medicare enrollees is building steadily to a crest, with the expectation of 40 percent growth as baby boomers retire. 

Couple this influx with increasing obesity with an additional burden of chronic illness - and it is understandable that our health care system and others around the world are showing signs of stress. Taking these realities into account in new designs can help us meet the demands of a changing marketplace.

A toolbox for engineering resiliency into primary care 

Trying to get tomorrow’s work done with yesterday's tools is causing burnout across the primary care community. We have within reach a better toolbox that can optimize our efforts at redesign — and reduce burnout.

Lean management approaches empower frontline providers to engage in process improvement and restore an essential sense of control over the workplace. Design thinking leads us to novel solutions and engages end users in the iterative creation of useable products. 

Workflow science gets at the choke points in our practices and helps us to clear them out. Agile work methods allow for the fluid assembly of cross-functional teams to tackle challenges in an adaptable team-of-teams approach.

Advanced information technology expands the reach of primary care through digital platforms in our goal of meeting people where they are, while providing us with actionable knowledge at the point of service. 

And broader organizational models can support primary care providers in their daily work with better infrastructure and management expertise, making it easier to serve our patients, while exchanging the isolation experienced by many for a greater sense of community and mutual support.

These tools already exist and are in use around the country. To build resiliency, we must become master craftsmen in deploying this toolbox containing Lean, design thinking, workflow science, advanced technology, agile, and organizational design. 

The goal is to recapture the time we need in primary care to establish relationships with patients and to use our training and expertise to solve the real clinical problems they face.  

Integrating individual care and population health

On top of it all, we have to find thoughtful, creative ways to integrate traditional one-on-one care with population health. Personal relationships between providers and patients lie at the core of primary care and ultimately all of medicine. 

These relationships are the gravitational force that will hold population health models together over time, as we improve the health of individuals and entire populations over the decades and generations ahead. 

Primary care and medicine form one of the most complex of all human endeavors. It is this fundamental humanity that will always define us in our work and that we must preserve and strengthen in the new designs we bring forward.

Our approach at OptumCare

At OptumCare, we believe that the health care systems of the future must be built on a strong and empowered foundation of primary care. 

As part of the greater Optum® organization, we have access to the most advanced health care technology and resources in the country, in an enterprise committed to helping people live healthier lives and helping make the health system work better for everyone. 

We believe that we are in a unique position to help primary care serve as the key catalyst in this evolution — and we are looking to join forces with those who share this vision and are willing to work with us in meeting this great challenge.

 

The views and opinions expressed herein are those of the authors and do not necessarily represent the views of OptumCare. The views and opinions expressed may change without notice. 

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Sources

  1. The New England Journal of Medicine. Bridging the Hospitalist–Primary Care Divide through Collaborative Care. Last updated Jan. 22, 2015. Accessed July 31, 2017.
  2. Fortune. Kaiser Permanente Is Opening Its Own Medical School. Published Dec. 17, 2015. Accessed Dec. 7, 2017.
  3. The State of Obesity. Obesity Rates & Trends Overview.