Holy Capitalism: Origins, Workings and Energy Catalyst

The Evolution of Primary Care: Embracing Innovation While Protecting the Core Value
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Today, as patients and consumers experience a steady decline in primary care value, discontent has opened the door to new entrants looking to exploit innovation opportunities to address gaps in value. These disruptors include telemedicine providers and urgent care centers seeking to create access value, medical apps designed to empower patients to self-manage routine chronic conditions, mobile paramedical programs designed to meet home-based acute-care needs, and many other initiatives that are still in development. Nearly every large technology company is actively exploring ways to gain entry into the health care space, including Verily a Google company , IBM Watson, Amazon , Apple, Fitbit, and Facebook.

These disruptors from outside health care are seeking to identify and attack inefficiencies and thereby simplify the complexity and dysfunction that we have come to accept.

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Their goal is to eliminate non-value-added tasks, reduce system fragmentation, automate workflows, and improve process reliability across every link of the primary care value chain. All these innovators presume a steady march toward value-based care models.

Disruptors occasionally have been characterized as threats to primary care. If we take a step back with focused commitment to the core value proposition of primary care, then embracing these disruptive innovations actually may help to accelerate the successful evolution of primary care and better meet the needs of our patients.

New disruptors are purposefully deconstructing the four elements of primary care and are breaking existing paradigms for how each part can be more reliably, efficiently, and effectively created. CVS has 10, retail stores across the United States, employs thousands of pharmacists, and has a distributed delivery system of urgent care MinuteClinics , telehealth, and home care infusion Coram services at its disposal. One could envision that a percentage of the high-volume daily tasks that are currently completed by traditional primary care systems e.

Transformation could be accelerated if CVS were to invest its considerable resources to tackle other low-risk, high-volume inefficiencies rampant across traditional primary care medical homes, uncovering new capacity to create value for patients. Telemedicine and retail clinic disruptors seek better ways to create first-contact care value.

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For example, American Well and Carewell Urgent Care seek to optimize access for a limited set of straightforward conditions e. Population health management disruptors such as Optum Labs are working to augment primary care value by introducing novel asynchronous team-based workflows using artificial intelligence—augmented decision-making to organize reams of data. Automation technologies can remove high-volume, low-skill tasks preauthorization forms, simple electronic medical record [EMR] documentation, etc.

Given the current level of dysfunction and stress, any and all efforts to enhance primary care workflow and value are likely to be embraced by frustrated providers, even at the risk of optimizing one type of value at the expense of another. Despite longstanding evidence that effective primary care leads to better clinical outcomes and lower health care costs, the limited deployment of global budgets and capitation reimbursement has only stimulated pockets of redesign across the country. Existing primary care providers are constrained by a lack of available funds that would allow for rapid transformation.

Effective and meaningful redesign of frontline workflows requires the support of expensive and limited IT resources to adapt EMR systems, integrate third-party tools, and so on.

Even with the rapid proliferation of consulting firms such as Evolent and Navigant to assist with primary care transformation, there is a lack of clinical, technical, and financial expertise to successfully transform from a fee-for-service world to a value-based delivery world.

The sluggish changes in traditional primary care models is disheartening, contributing to clinician burnout and care that increasingly falls short of patient expectations. With a shared collective vision that prioritizes patient value, the growing legion of external disruptors are poised to offer meaningful help and hold the potential to return the luster to primary care, once again making it a specialty in high demand. It is a near certainty that the practice of primary care will change. The trick is to channel the growing energy, capital, and enthusiasm in innovation to enhance the core value proposition of primary care.

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The speed with which we realize these changes will be a function of how rapidly we commit resources: people, technology, political will, and capital. Whether primary care clinicians will survive as independent practitioners is an important question but distracts from the critical importance of reengineering, enabling, and radically improving practice for both clinicians and patients. While traditionalists may abhor the potential for these innovations to disrupt the face-to-face visit and the sacred patient-clinician trusted relationship, the integration of modern connectivity innovations to augment our system of care could enable and enhance the development of longitudinal trusted relationships in an increasingly mobile, fast-paced 21 st -century society.

Many of these innovations will make care more accessible, more reliable, more evidence-based, more cost effective, and more transparent. Disruptive innovations have the potential to rapidly provide new snippets of value for patients and communities. However, the true potential will be fully realized only when they are systematically repatriated and integrated back into the primary care medical home and into an organized system of care.

The collective augmentation of the four synergistic elements of the primary care value proposition holds the potential for exponential improvement in the value of primary care services. It will be an uphill battle that will be hard to resist. Steven Strongwater, MD, leads 6, employees serving , patients across eastern Massachusetts with coordinated medical care, home health, and hospice. Learn more about Steven Strongwater The only 'disruptors" in healthcare today are the government of the United States and it's cronies in academia who have consistently failed in their quest for the 'modern efficient administrative state' and their need to control!

Calling the potential innovation of the free market a disruptor is totally disingenuous and self serving. In terms of primary care, the free market is saving it with concepts like concierge medicine. Not one program developed by any central planner has improved medical care in this country in the last 50 years. Not one! Let freedom and individual choice guide the system not failed central planning. Allen Cookson. The Price of Carbon.

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