Priorities for a primary care overhaul

Primary care providers will drive the overhaul of the health system when they focus on the value to patients of their care delivery to produce measurably better outcomes. That's the view of Michael Porter, Harvard Business School professor, researcher and author, who explained value-based healthcare delivery in conjunction with outcome measurement during a presentation at the Nashville Health Care Council on March 15.

Value is the actual health outcomes that patients achieve to solve their problem divided by or compared with the actual cost to achieve those outcomes, said Porter, whose talk was broadcast live to reporters.

“If we can deliver excellent outcomes and do it efficiently, then the problems of insurance and healthcare that we have been struggling with and that are breaking our budget will dramatically subside,” Porter said.

A critical part of getting healthcare delivery right, he noted, is to align financial success for the provider with success for the patient and competing on those terms. “That is a function in part of the regulatory structure that gets created from outside and partly a function of how health plans and providers work together and create the right rules of the game,” he continued.

Porter recommended six priorities to overhaul primary care delivery to achieve value:

1. Reorganize care delivery around patient needs or sets of conditions instead of around the supply of services.

2. Measure value for every patient as they go through the lines of care for outcome and costs tailored to patient subgroups.

3. Change the payment model to some form of bundle for a complete care process for a certain problem, such as a defined group of services.

4. Integrate healthcare delivery across systems to coordinate care and away from healthcare system units operating in "silos."

5. Spread excellence over geography to fill in gaps in rural areas or to offer care for particular diseases in broader regions, including through new types of affiliations and partnerships between community hospitals and more academic, tertiary and high-end hospitals.

6. Get the right IT platform that enables care to be integrated so that all the information is in the same place and accessible to those involved in the patient’s care. Health IT systems need to make measurement easy and enable all on the patient care team to coordinate and connect.

Photo credit: Nashville Health Care Council