Lauren Cheung, MD, MBA
The Future of Primary Care
Lauren Cheung, MD, MBA
The Future of Primary Care
If recent news headlines are any indication, primary care is at a crossroads. A combination of rising health care costs, antiquated care models, increased patient demand, and an anticipated shortage of physicians has stressed existing systems, creating what many refer to as a “primary care crisis.”
In the face of this grim picture, health care providers are rethinking the primary care paradigm, coming up with new, innovative ways to deliver care and improve patient experiences. Stanford has been at the forefront of this movement, working to transform and revitalize the field.
Primary Care 2.0
Imagine a place where your health care is tailored to your lifestyle. Your minor medical issues can be handled remotely, your physician works with a multi-disciplinary team, and your care is continuous, affordable, and preventive. That’s the idea behind “Primary Care 2.0,” a new Stanford initiative dedicated to providing high-value patient care.
“Primary Care 2.0 aims to rethink and transform the way we practice,” says Megan Mahoney, MD (clinical associate professor, General Medical Disciplines).“Today’s primary care field is somewhat broken; patients feel that they don’t get to spend enough time with their provider and that physicians are less focused on wellness and prevention.”
The current system also puts a strain on providers. As Mahoney explains, “Providers feel very burnt out. Primary Care 2.0 has given us the chance to ask: How do we increase the value of what we’re doing?”
Primary Care 2.0 is a blueprint for the future. It builds on Stanford’s commitment to excellence in patient care while improving coordination of care, access to services, and patient experience. “It’s more than a system, it’s a new way of operating,” says Mahoney. “It’s flexible, so patients will be able to access us how they choose; it’s proactive, so we’ll be reaching out to patients between visits; and it’s designed to ensure continuity.”
Today, a team of physicians, designers, pharmacists, and others are working to bring this blueprint to life. The team is planning a clinic demonstration site that will be intuitively designed to incorporate the principles of the Primary Care 2.0 model. “For example, if a patient came in for a visit and they wanted to sign up for MyHealth—Stanford’s web-based health management platform—we would have a tablet in reception for them to sign up, as well as a video that would walk them through the process. As soon as they registered, their information would be sent to their care team.” Once the demonstration site opens, the Primary Care 2.0 team will continue to iterate their new model. “We’ll be learning from our clinic,” says Mahoney, “and we’ll be able to improve and perfect what we’re doing.”
If recent news headlines are any indication, primary care is at a crossroads. A combination of rising health care costs, antiquated care models, increased patient demand, and an anticipated shortage of physicians has stressed existing systems, creating what many refer to as a “primary care crisis.”
In the face of this grim picture, health care providers are rethinking the primary care paradigm, coming up with new, innovative ways to deliver care and improve patient experiences. Stanford has been at the forefront of this movement, working to transform and revitalize the field.
Primary Care 2.0
Imagine a place where your health care is tailored to your lifestyle. Your minor medical issues can be handled remotely, your physician works with a multi-disciplinary team, and your care is continuous, affordable, and preventive. That’s the idea behind “Primary Care 2.0,” a new Stanford initiative dedicated to providing high-value patient care.
“Primary Care 2.0 aims to rethink and transform the way we practice,” says Megan Mahoney, MD (clinical associate professor, General Medical Disciplines).“Today’s primary care field is somewhat broken; patients feel that they don’t get to spend enough time with their provider and that physicians are less focused on wellness and prevention.”
The current system also puts a strain on providers. As Mahoney explains, “Providers feel very burnt out. Primary Care 2.0 has given us the chance to ask: How do we increase the value of what we’re doing?”
Primary Care 2.0 is a blueprint for the future. It builds on Stanford’s commitment to excellence in patient care while improving coordination of care, access to services, and patient experience. “It’s more than a system, it’s a new way of operating,” says Mahoney. “It’s flexible, so patients will be able to access us how they choose; it’s proactive, so we’ll be reaching out to patients between visits; and it’s designed to ensure continuity.”
Today, a team of physicians, designers, pharmacists, and others are working to bring this blueprint to life. The team is planning a clinic demonstration site that will be intuitively designed to incorporate the principles of the Primary Care 2.0 model. “For example, if a patient came in for a visit and they wanted to sign up for MyHealth—Stanford’s web-based health management platform—we would have a tablet in reception for them to sign up, as well as a video that would walk them through the process. As soon as they registered, their information would be sent to their care team.” Once the demonstration site opens, the Primary Care 2.0 team will continue to iterate their new model. “We’ll be learning from our clinic,” says Mahoney, “and we’ll be able to improve and perfect what we’re doing.”
ClickWell Care
ClickWell Care, a new virtual online clinic staffed by Stanford physicians, is another innovation designed to upend the traditional primary care model. Armed with a laptop or a cell phone, patients who are enrolled in the ClickWell program can choose to meet with their doctors virtually, without having to take time out of their day to travel to a clinic. Or they can opt to meet their clinician in person. “ClickWell leverages technology to make care more accessible and convenient,” explains Sumbul Desai, MD (clinical assistant professor, General Medical Disciplines). “We empower patients to connect with us in the way they see fit.”
So far, the program seems to be working. “We’ve had really good traction, and a lot of return business. About 90–95% of patients who start with ClickWell stay with ClickWell.” Providers have also expressed enthusiasm. “The mix of in-person, phone, and video seems to create less burnout for physicians. They find that it’s a nice way to interact with their patients,” says Desai.
Another aspect of ClickWell that has been well received is the virtual wellness coaching. Wellness coaches—usually fitness trainers and nutritionists—can work with patients to help them meet specific health goals, like losing weight or training for a marathon. They’re also an integrated part of the patient’s care team, and they work closely with the primary physician. “Patients can see a wellness coach as frequently as they want,” says Desai, “and they’re really able to see the coach as a partner in their overall health.”
Inspired by their recent success, the ClickWell team is now working to expand their program. “Going forward, we’ll continue to test and tweak the model with larger patient populations.”
Across town, Karl Lorenz, MD, MSHS (professor, General Medical Disciplines), who is based at the Veterans Affairs Palo Alto Health Care System (VA), is waging his own campaign to change the culture of palliative care.
Lorenz’s passion for these issues began in 1998, when he heard his mentor Joanne Lynn speak at UCLA about the failure of the SUPPORT study – an ambitious, $29 million effort sponsored by the Robert Wood Johnson Foundation to improve end-of-life care. Like Harman, he had a significant realization: “I realized for the first time that I was a bad provider of end-of-life care. But part of the reason was that I’d never received any training, and that I had never thought about it as an aspect of practice that I should be good at. I suddenly realized that I was going to have one crack at making a difference, and I wanted to be doing something that no one else was paying attention to, because I realized what a cost it had been in the past for my patients and me. And I didn’t think that was right.”
Lorenz committed himself to the field of palliative care, and began to work closely with leadership from the VA. “One of my earliest experiences was meeting James Hallenbeck, the associate chief of staff for Palo Alto VA, and sharing in some of the early meetings that established palliative care training programs through the VA’s Office of Academic Affiliations,” he recalls. Along with Randall Gale, PhD, an investigator at the Palo Alto VA, Lorenz now directs a national resource center that develops provider-facing informatics tools for the electronic health record to improve palliative care.
The VA and Stanford Health Care palliative care programs each bring great strengths to the table. “Traditionally the two programs have operated fairly independently,” says Harman. “Collaboration will be a great opportunity to share best practices and resources, to learn from each other, and also to build up a much more robust academic section with research, education, and clinical programs.” The teams are evaluating the current palliative care landscape to develop a core set of program priorities and goals. As Lorenz explains, “We’re currently in the middle of an assessment process. One of our goals is to think through the advantages of our existing programs and resources and identify where the gaps are to prioritize some direction for us as a group.”
They also have plans to expand education and training efforts and leverage new technologies to support palliative care. “This is a great opportunity to innovate and to think more broadly about using technology in palliative care training, education, and delivery,” says Harman. Lorenz agrees, adding: “We’ll get to test and identify the technologies and models of care that will best serve the needs of patients and their families.”
Research is another key component of the combined VA-Stanford palliative care program. Several projects are already in the pipeline, including an examination of ways to spread palliative care within cancer practice by Manali Patel, MD (instructor, Oncology) and Risha Gidwani, DrPH (consulting assistant professor, General Medical Disciplines); and innovative research on end-of-life communication modes by VJ Periyakoil, MD (clinical associate professor, General Medical Disciplines). “We want to be doing cutting-edge research that is not only cited elsewhere but is adopted,” notes Lorenz.
A robust and effective academic partnership will be a reflection of Stanford’s commitment to palliative care, says Lorenz. “This will be an opportunity to think about what palliative care can really mean within the Stanford Health Care system. Veterans, patients, and their families all have much to gain from a growing program aspiring to excellence in palliative and end-of-life care.”
Today, a team of physicians, designers, pharmacists, and others are working to bring this blueprint to life. The team is planning a clinic demonstration site that will be intuitively designed to incorporate the principles of the Primary Care 2.0 model. “For example, if a patient came in for a visit and they wanted to sign up for MyHealth—Stanford’s web-based health management platform—we would have a tablet in reception for them to sign up, as well as a video that would walk them through the process. As soon as they registered, their information would be sent to their care team.” Once the demonstration site opens, the Primary Care 2.0 team will continue to iterate their new model. “We’ll be learning from our clinic,” says Mahoney, “and we’ll be able to improve and perfect what we’re doing.”
ClickWell Care
ClickWell Care, a new virtual online clinic staffed by Stanford physicians, is another innovation designed to upend the traditional primary care model. Armed with a laptop or a cell phone, patients who are enrolled in the ClickWell program can choose to meet with their doctors virtually, without having to take time out of their day to travel to a clinic. Or they can opt to meet their clinician in person. “ClickWell leverages technology to make care more accessible and convenient,” explains Sumbul Desai, MD (clinical assistant professor, General Medical Disciplines). “We empower patients to connect with us in the way they see fit.”
So far, the program seems to be working. “We’ve had really good traction, and a lot of return business. About 90–95% of patients who start with ClickWell stay with ClickWell.” Providers have also expressed enthusiasm. “The mix of in-person, phone, and video seems to create less burnout for physicians. They find that it’s a nice way to interact with their patients,” says Desai.
Another aspect of ClickWell that has been well received is the virtual wellness coaching. Wellness coaches—usually fitness trainers and nutritionists—can work with patients to help them meet specific health goals, like losing weight or training for a marathon. They’re also an integrated part of the patient’s care team, and they work closely with the primary physician. “Patients can see a wellness coach as frequently as they want,” says Desai, “and they’re really able to see the coach as a partner in their overall health.”
Inspired by their recent success, the ClickWell team is now working to expand their program. “Going forward, we’ll continue to test and tweak the model with larger patient populations.”
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