Abstract
The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. Rising healthcare costs, high rates of waste, the continued trend towards chronic non-communicable disease, and the growth of new market entrants that compete with primary care services have set the stage for fundamental change in all of healthcare, driven by a revolution in primary care. We believe that the coming primary care revolution ought to be guided by the following design principles: 1) Payment must adequately support primary care and reward value, including non-visit-based care. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an ever-increasing role in most aspects of healthcare. 3) Generalist physicians will increasingly focus on high-acuity and high-complexity presentations, and primary care teams will increasingly manage conditions that specialists managed in the past. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training.
Highlights
Primary care has been described as Bintegrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.^1 This and other seminal definitions of primary care do not specify a type of clinician, but rather refer to the set of essential functions which primary care serves within healthcare systems—namely, access, continuity, comprehensiveness, and coordination.[1,2,3]
We argue that primary care serves critical functions that will be as vital in the future as they have been in the past, and that these functions may be more optimally achieved through different configurations of people and technology, guided by four principles
The patient-centered medical home (PCMH) is a construct for team-based primary care oriented towards improving the health of a panel of patients
Summary
The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an everincreasing role in most aspects of healthcare. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training
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