Implementing High-Quality Primary Care Rebuilding the Foundation of Health Care (2021) / Chapter Skim
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2 Defining High-Quality Primary Care Today
2 Defining High-Quality Primary Care Today
Pages 45-70
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From page 45... ...
While these ideas were widely embraced as ideal (Halfon and Hochstein, 2002; IOM, 2012; Starfield et al., 2005) , progress has been markedly limited in making them a reality for most primary care practices (Frey, 2018; Larson et al., 2005; Levene et al., 2018)
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From page 46... ...
definition was still highly relevant, it felt that the definition did not fully capture certain important shifts in primary care since 1996. Specifically, the committee felt an accurate, contemporary definition should • shift the emphasis from the provision of health care services to integrated, whole-person health; • emphasize the foundational sustained relationships at the core of high-quality primary care; • recognize the importance of communities and their critical roles in the provision of primary care; • highlight the need for primary care to be equitable; • recognize the interprofessional care teams that deliver primary care; and • acknowledge the diversity of settings (and modalities used)
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From page 47... ...
DEFINING HIGH-QUALITY PRIMARY CARE TODAY 47 articulates the committee's vision and represents what this report's recommendations and implementation strategy broadly seek to achieve. Figure 2-1 visualizes what high-quality primary care can look like for a family in the United States, showing how it is based on strong relationships between the interprofessional primary care team and the individual, Community SCHOOL Primary Care Secondary/Tertiary Care FIGURE 2-1 A visual representation of high-quality primary care.
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From page 48... ...
Primary care's documented salutary effects for population outcomes and equity (and BOX 2-1 Primary Care as a Common Good The committee's position is that high-quality primary care, distinct from most other health care services, is a common good, delivering benefits for society and to individuals. Fundamentally, the committee holds that primary care is essential to the American values of "life, liberty and the pursuit of happiness" and merits status as a common good.
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The evidence supporting the importance of primary care relative to other health care services is strong and convincing (Basu et al., 2019; Levine et al., 2019; Macinko et al., 2003; Shi, 2012)
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. While treating, diagnosing, and managing acute and chronic conditions are core functions of primary care, providing whole-person care requires a comprehensive person-centered, integrated approach based on relationships that account for mental, physical, emotional, and spiritual health and the social determinants of health in the context of community experiences (Ellner and Phillips, 2017; Feuerstein et al., 2016; Ring and Mahadevan, 2017; Sia et al., 2004)
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See Chapter 4 for more on primary care relationships. The Role of the Community For decades now, community involvement in delivering primary care has been recognized as critical to help achieve whole-person health goals.
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. Using interprofessional primary care teams that reflect the communities they serve, within an integrated system that supports building and developing relationships with individuals, families, and communities, is integral to achieving health equity.
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. Furthermore, interprofessional care teams should ideally be highly engaged in promoting population health in the communities in which they are practicing and addressing community needs that impact health.
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The first five (payment models, accountability and improving quality, digital health care, interprofessional care teams, and research) have dedicated chapters in this report.
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Payment models that support integrated, interprofessional teams working in sustained relationships with patients will ensure that high quality primary care is possible to implement and sustain.
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. Health care practices and systems will need financial support to transition toward a more integrated, team-based primary care delivery model (primary care payment is discussed further in Chapter 9)
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Within the care team, digital health tools should enable team members to seamlessly communicate with each other, share patient data, effectively monitor patient populations, and do their jobs more efficiently without contributing to professional burnout. Digital health data can provide valuable metrics on care delivery and patient outcomes, and digital health technologies have promise for use in changing and shaping health behaviors, helping with patient- and familylevel prevention and care management, and incorporating health-related data across sectors outside of health, such as education and community (Nittas et al., 2019; Vassiliou et al., 2020)
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From page 58... ...
The breadth of skills that a well-functioning team of diverse clinical and non-clinical professions offers can more comprehensively support the whole-person health goals of primary care than any individual clinician is capable of doing. Primary care teams today need preparation to function in integrated systems with multiple types of health care workers and others in the community supporting the goals of primary care.
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Research using primary care–specific metrics could also lead to creating a primary care learning health system. Leadership Primary care lacks a focal voice for its own advocacy, which may be the most important reason why the IOM's 1996 recommendations were not implemented.
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Secretary broad powers to determine Medicare payment rates and adjust the program's physician fee schedule to reflect payment for specific types of care. The Medicare fee schedule plays a role far beyond Medicare itself, since it is used as a payment benchmark by private insurers and employer health plans and thus largely determines the range of primary care procedures that will be compensated along with their payment levels, as well as the classes of health professionals who are qualified to directly bill the program and receive payment in their own right (Clemens et al., 2015)
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State health professions practice acts, implementing regulations, and a web of legal rulings establish licensure competency requirements and the range of health care services each health profession may provide and under what conditions. This power has the effect of exposing health care practice itself to the political decisions of individual states, rather than ensuring that decisions regarding the regulation of health care practice are based on education and training competencies and evidence (IOM, 2011)
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From page 62... ...
. Fully addressing the policies, laws, and regulations that enable and perpetuate societal inequalities and inequitable health care is beyond the scope of this report; however, legal, regulatory, and policy changes can improve equitable access to high-quality primary care regardless of insurance status, facilitate improvements to the care delivered, and enable the integration of that care with the broader health care system.
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2019. Building powerful primary care teams.
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Journal of the American Board of Family Medicine 29(Suppl 1)
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Journal of the American Board of Family Medicine 29(Suppl 1)
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2017. Identifying primary care quality indicators for people with serious mental illness: A systematic review.
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Journal of the American Board of Family Medicine 31(6)
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2020. Clinical quality measures in a post pandemic world: Measuring what matters in family medicine (ABFM)
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2018. Integrated primary health care-based service delivery in the global conference on primary health care, Astana, Kazakhstan.
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