There’s a window of opportunity closing on American health care.
Before we rush ahead to digitize and automate much of care delivery, we still have time to take a step back to reconsider how to improve patient outcomes and issues with source data. Otherwise, the adoption of new technology will only speed up flaws in existing practice workflows.
I believe we can align the pieces of the puzzle in local pediatric systems of care. With the same total dollars that we already spend per child, we can shift more resources to primary care teams by paying them to take the lead in integrated case management. Through the use of value based care, pediatric practices of all sizes can play the role of a conductor leading an orchestra
The dilemma of primary care medicine
Primary care physicians (PCPs) typically operate in an environment of downward pressure on revenue in fee-for service reimbursement rates, while expenses continue to increase. As a PCP, you’re probably forced to make decisions based on a patchwork of data received from many different external sources. Meanwhile, your staff can feel like they’re running on a hamster wheel as the care team has to react to everything happening around them.
Among the many limitations placed on PCPs, three stand out to me:
Implementation of electronic medical records (EMRs) without understanding the tasks or jobs to be done by the multidisciplinary care team
Erosion of the physician-nurse dyad that previously led primary care workflow
A shift of weighting in insurance reimbursement code values from PCPs to specialists in Congress’ zero sum methodology known as the resource-based relative value system
Every primary care practice in America will need to adopt more automation in their daily workflows (through AI) before 2030 to continue to financially breakeven.
Will you redefine how you care for patients, or will a software template dictate that?
Moving primary care back to the forefront
To improve clinical outcomes and the experience of everyone involved (patients, clinicians, and nurses), let’s reorganize today’s care delivery model by placing the primary care team back at the center of the picture to facilitate better outcomes. This means using creativity to increase funding for primary care and provide better data for more informed decision making at the point of care. We’ll also need to negotiate changes to administrative oversight like waiving prior authorizations for practices that meet mutually agreed upon quality criteria.
Physicians, practice managers, and facility administrators will need to lead their own problem-solving efforts in 2025; instead of relying on the U.S. government policy changes.
Along the way, we’ll need to define and prioritize patient outcomes metrics that reflect health status and quality of the patient experience.
A few caveats
In this series of articles, I don’t address health policy debates in Washington, D.C. I recognize the limitations of current health care delivery design established by policymakers over the past several decades. The designs have diminished capabilities in primary care and rural health across all specialties for recruiting, training, retention, and use of facilities.
Neither do I cover spikes in the rates of chronic health conditions largely caused by consumer lifestyle decisions and a fragmented framework of community resources. Lack of appointment availability for preventive health services and limitations in community resources has contributed to gaps in children’s health related social needs increase the downstream challenge for clinicians treating kids:
Inconsistent transportation to medical, and behavioral health appointments
Food insecurity
Housing instability
Let’s reorganize the pediatric care delivery model by putting the primary care team back at the center to coordinate care and empower them with actionable data. They understand what their patients often need before complications led to acute events.
POLL 👉 What’s the top barrier pediatric primary care teams face in improving kids’ outcomes?
A strawman for your scrutiny
It’s time to return to a care delivery model driven by pediatric primary care. In a series of upcoming weekly articles, I’ll pose questions to confirm assumptions about the primary care team’s unmeet needs. We need to understand nuances of problems before you can jump to solutions:
Article 1: How to identify outcomes to measure for children and adolescents meaningful to your practice. We can select outcomes metrics as part of a balanced scorecard that your practice management system automatically tracks.
Article 2: How to fund the care model. We can go beyond the current constraints of existing fee-for-service, value-based care, and subscription-based reimbursement models to earn outcomes-based payments according to your terms.
Article 3: How to best investigate the needs of patients. We can collect and aggregate multiple sources of data to paint a more complete picture for clinical decision-making.
Article 4: How to stratify existing patients into cohorts. We can use data analytics software to anticipate patient needs for care team action items.
Article 5: How to intervene on behalf of patients who have varying needs. We can define how the team can engage patients to strengthen the primary care relationship through communication, education, and self-care across the patient journey.
Article 6: How the care team can monitor each patient’s progress through an iterative quality loop across the patient journey. We can define parameters for each patient record to prompt interactions with the care team.
I want to facilitate conversation about how to tackle the underlying issues in primary care care delivery based on today’s constraints. You’re welcome to email me at [email protected] with your thoughts.
Coming Soon: In this upcoming series of articles, I’ll highlight evidence-based practices used by select health care organizations today to achieve meaningful results. I’ll offer a strawman for each phase of the primary care team’s journey to improve outcomes for kids.
Playbook: Phases of the primary care team’s journey 👇
