No matter what position your health system is in, you’ve got a primary care practitioner problem.
Either you haven’t employed or befriended enough of them, and your competitors have locked up primary care referral streams. Or you do have a well-structured and effective primary care network, but it’s just not large enough to meet all the demands for primary care in your community.
It’s a problem that’s only going to get worse, since primary care is the cornerstone of population health management, and the strength of your primary care network could mean the difference between accountable care success and failure.
A non-traditional solution
I’ve been wondering whether we will start seeing health systems partner more aggressively with non-traditional providers of primary care—for example, the Walgreens Take Care Network—to fill holes in their primary care capabilities.
Over the past decade, we’ve fielded hundreds of inquiries from our health system members about the retail clinic phenomenon. Though the track record for retail clinic partnerships has been mixed, some health systems continue to see clinic ownership or affiliation as a way to strengthen their local brand and to capture downstream volumes.
But you could imagine a broader way to look at the clinic market, as a way to address your primary care capacity shortfalls. By now, it’s well known that Walgreens has been expanding its clinic capabilities to include the diagnosis and management of chronic conditions. Isn’t cost-effective chronic care what’s in short supply in many markets around the country?
It’s not as simple as I’m posing it, of course. There are legitimate questions about how a provider like Walgreens would integrate into a health system’s population management strategy, and all the players involved would need to resolve issues of IT integration, care protocols, and cultural alignment.
Looking beyond physicians
But whether it’s with an organization like Walgreens or through another model, I’m increasingly convinced that the solution for our population health management challenges can’t rely on physicians.
When I was in medical school, we certainly weren’t trained in the approaches, interaction styles, and competencies that are most important for population health management. And I don’t think the curriculum has evolved very much since then.
In part, this is because many of the most challenging aspects of population health management aren’t medical, at least not in the strictest sense of the word. In the real world, people often suffer from medical problems because of their lifestyle choices and because of their social circumstances as much as from disease processes.
Physicians are too expensive, too scarce, and (candidly) often too rushed to do a great job addressing the underlying causes of disease, especially the non-medical causes. And that often leads to needless utilization of health care services.
How many times a day do patients go to the doctor with high cholesterol and leave with a Lipitor prescription? Countless times.
But how often does the doctor take the time to really talk with the patient about the lifestyle choices that are contributing to the high cholesterol? And how many doctors are skilled enough at behavior modification and lifestyle coaching that they can lead the patient through the necessary steps to get them to make meaningful lifestyle improvements—asking, “Let’s look at your diet? What’s the one thing you can change next week?” And how many doctors follow up frequently and consistently to make sure the patients are making the changes they are recommending?
All too rarely.
I don’t want to get in trouble with my physician peers. But you could certainly make an argument that the right answer is not to retrain physicians and restructure their appointments, but rather to send chronically ill patients to see advanced practitioners who will do a better job at a more economical cost.
Learn More at our National Meeting
We’re looking at the how best to provide population health services to low-risk patients at our upcoming Health Care Advisory Board national meeting series. If you’re at all engaged in population health strategy or implementation, I strongly recommend you attend.
JOIN US AT A CITY NEAR YOU
In the meantime, you can preview our research on ensuring access for low-risk patients, and watch an on-demand webconference on advanced practitioners and team-based care by my colleagues at the Medical Group Strategy Council, which lays out the nuts and bolts of effective AP-physician collaboration.
Chronic Care Management,