Let’s not forget Primary Healthcare

I stumbled on this excellent report on primary healthcare. The report highlights are here:

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An accompanying HBR write up

But current efforts to wring “value” from primary care by focusing on diagnostic algorithms and quality metrics reveal fundamental misunderstandings of primary care’s purpose. The attempts to apply processes and technology designed for subspecialty care to the delivery of primary care have proven insufficient to support the complex work of the primary care team.

Primary care is unique in health care. It cannot be managed the same way as other parts of health care where the emphasis has rightly been on streamlining and cutting waste from a bloated system. At the heart of primary care’s success remains a unique relationship between physicians and patients built on trust.

This is an interesting insight. There’s something more from the write up:

Fix EHR technology. Incentives in the 2009 stimulus plan created a “big bang” for EHR technology, in which the federal government unwittingly subsidized thousands of “certified” systems that were already antiquated and were designed primarily to drive medical billing performance in a fee-for-service, subspecialty-driven landscape. Today, physicians across the United States are largely trapped in legacy technology entirely unprepared for a value-based, patient-relationship, collaborative-care future. Technology must be redesigned to be “clinical first” and integrate the entire health care ecosystem to make it easy to access and share information across systems. It must be purpose-built to remove barriers, unburden human effort, and create new capabilities while encouraging the best decision-making for patients, providers, and payers.

I face a different predicament, patients have increasingly been accustomed to seeking pharmaceutical based therapies – instead of lifestyle modifications. I prescribe exercise as a matter of principle – though I don’t win popularity contests for insisting on weight loss – the link between obesity and cancer is onerous, and both complicate each other’s outcomes.

There’s a long haul towards primary healthcare – going back to the roots of why we decided to become physicians in the first place.