Making Primary Care The Primary Focus

Topic: Fixing healthcare.

Ron Dixon: There are a number of things that could address this problem. I think the primary one is the role of so-called primary care as the front line for healthcare delivery, really needs to be reinvented. There are several opportunities to innovate around what a so-called primary care physician does.

Unfortunately, since the current model rewards physicians for actually doing things, such as procedures, as opposed to thinking about things and coordinating things, we don’t really have a workforce that is engaged in thinking innovatively about primary care and primary care delivery.

If you are able to start thinking about paying for efficiency, paying for so-called performance, paying for coordination of care and paying for a person who acts as the pinpoint for the patient, paying in a way for that relationship between that primary care provider and the patient, then you would have a way to build some efficiencies into the system.


Question: What is patient-centric care and why does it matter?

Ron Dixon: I think patient-centric care is really the ethos of primary care. We as general internists, pediatricians and family doctors are really interested in doing what’s best for the patient. I think that can become rather difficult given the pressures put upon us by folks who actually pay for the care, because sometimes they might be more interested in what is the actual cost of providing care for a population.

There are two counter-intuitive forces at hand here. You want the best care for your patient who is sitting in front of you, who might be a diabetic, but then you also want the best care for the population of diabetics within a practice.

Primary care doctors don’t really have the tools to provide both, and what we end up doing is providing patient-centric care, but not in the way that we would like to do it, simply because we don’t have the time to really sit and talk with patients and think about informed decisions. We want patients to have the information and then be able to make shared decisions with the primary care doctor as the person who’s sharing that decision with the patient.

So, that would really be what patient-centric care is about. Unfortunately, in today’s environment we don’t typically have time to practice it.

Well, right now again we’re paid for what we do, which is actually perverse incentive, so it makes us do more. That’s one of the reasons I think you’re seeing the cost of healthcare rise 8% in terms of inflation per year. Now, that obviously can’t continue, and [Barack] Obama has some proposals on the table to reduce that increase by 1.5% per year over the next few years.

I think however, if you start to pay for performance, pay for quality, pay for efficiency, then you eliminate these types of incentives.

If a patient has diabetes and can self manage their blood sugars, which a lot of patients do, but now we have a tool which enables the physician or the care provider to actually see those self management values and work off of those to help coach the patient as to how better manage their blood sugars and behavior, then it doesn’t matter where that management is taking place. If that management is taking place at the home, but the outcome in terms of quality is good or better than the visit-based model, then you have incentives to provide this type of care.


Recorded on: May 28, 2009.

Medical expert Ron Dixon says we need to eliminate perverse incentives from healthcare and start paying for performance and quality.

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