By Verdon, Daniel R.
Medical Economics , Vol. 90, No. 4
The future and success of primary care may rest on its ability to engage patients in entirely new ways.
Driven by cost containment, adoption of technology, the need for patient transparency, and a kind of re-engineering of the healthcare team, David Judge, MD, founder of the Ambulatory Practice of the Future at Massachusetts General Hospital (MGH) in Boston, is betting on primary care and has built a kind of learning laboratory to test models to improve the quality of care and build teamwork. Long-term, Judge believes the efforts will help lower costs to his patients by reducing hospitalizations and visits to emergency departments.
Judge, an internist and assistant medical director at the Bulfinch Medical Group at MGH and coprogram leader in clinical systems innovation at the Center for the Integration of Medicine and Innovarive Technology (CIMIT), believes that primary care needs to be reinvented to improve its economic base and solve some of the most vexing problems confronting it, such as physician and nurse burnout, dwindling shortages of primary care physicians (PCPs), and low reimbursements at a time when healthcare is moving to improve care, juggle more patients, and still remain economically viable.
Judge should know. He built a busy internal medicine practice and concluded there simply had to be a more effective way to deliver care than in 15-minute time slots.
His answer is a 7,200-square-foot primary care practice, costing more than $2 million, built on the premise of testing different business and clinical care models in an attempt to redefine the rules of patient engagement He also is looking to contribute to the growing body of evidence supporting the premise that if you engage patients in their healthcare, it will improve their health status and ultimately reduce long-term healthcare costs.
Leaders within MGH bought into the concept, and the practice opened in 2010 in collaboration with the Mass General Physicians Organization, the Stoeckle Center for Primary Care Innovation, and the CIMIT.
Patient engagement not only is a critical component of healthcare reform, it is a cornerstone to the concept of a Patient-Centered Medical Home and accountable care organization, according to a Health Affairs report titled "What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs" by Judith H. Hibbard, et al.
Although the report states that not a lot of evidence exists to date about the impact of costs associated with an engaged patient, Judge believes his practice is showing some evidence of bending this cost curve.
So what is a primary care practice of the near future?
Imagine a time when you are conducting 35% of your follow-up care appointments through video conferencing, or patients are booking their own appointments through an open-source network. Imagine building a "living room" as patients enter your clinic that is so Web-enabled patients that can review their records, educate themselves on their health, and even conduct research about their own conditions in the clinic. Imagine a time when patients can access all of your notes about their health, even if they have a poor diagnosis or prognosis. Imagine a time when a health coach sits down with your patients and shows them how to safely exercise with cardio machines and weights. And imagine a time when the primary care clinic facilitates support groups with other patients in the practice with the same chronic conditions, such as diabetes, or when the practice truly manages the health ofthat patient population whether in a primary care setting or referred on to specialist consultations.
And although many of these concepts are in play in practices across the United States, their integration into the service mix and practice workflow could help position primary care from mostly delivering episodic care to facilitating wellness among the majority of its patients. …