Primary Care Leads the Population Health Revolution

By Dennis Archambault

Wayne County, which has the lowest health ranking of any county in Michigan and many counties across the nation, has four health systems (actually, three, now that Oakwood Healthcare has joined Beaumont and Botsford hospitals) and one of the nation’s largest medical schools. The quality of medical care is about as good as it gets in Michigan, yet this doesn’t translate into the health of people living in Wayne County. The Robert Wood Johnson Foundation County Health Rankings http://www.countyhealthrankings.org/ repeatedly list Wayne County at the bottom of the state’s county rankings.

Health systems are driven by the “sick care” model, steeped in specialty care, and oriented to emergent and critical needs for an unhealthy population. Most of the health systems in the region train medical residents, and most of these residents look to specialties that allow them to enjoy an affluent lifestyle and practice in hospitals or suburban specialty practices. About 60 percent of the patient visits in the United States occur in hospital specialty practices, resulting in about 95 percent of health care expenditures, which is an unsustainable social expense.

Nothing really new here: Voices crying in the community health wilderness have assailed these misdirected resources for some time. But the time has come for primary care providers, uniquely positioned at the intersection of health care delivery and social determinants of health, to lead “the 21st century revolution,” according to “Primary Care Must Lead on Population Health,” written by Theodore Long, Ali M. Khan, and Nav Chana, published this summer in the journal Postgrad Med (http://pmj.bmj.com/site/about/).

If the call to leadership isn’t enough, the authors bemoan the “disturbingly high lack of engagement” and burnout of primary care providers. In the United States, “even in the face of a looming shortage of up to 44,000 adult care generalists by 2025, nearly two-thirds of primary care internal medicine residents do not report an interest” in primary care specialties.

Young physicians need to realize that the times are changing and that “the whole of the health care community needs to listen and support the shift to population health.”

The physicians training in the Authority Health teaching health center program have heard the call and are learning community-based practice skills, steeped in population health knowledge, reinforced by a population health certification program provided through the University of Michigan School of Public Health. Six primary care specialties — family medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and geriatrics — are leading the revolution.

But it will take more than primary care providers upending the system — and commanding their just fiscal reward. Specialists will need to learn to become consultants to primary caregivers, rather than the dominant providers they have been. “This might mean, for example, that the responsibilities of a consultant respiratory physician would include not only caring for patients with respiratory disease…but also the respiratory health of the people in their locality… A new style of (collegial) leadership is called for to promote effective networking and federation, with perhaps less emphasis on the adversarial and competitive style of leadership,” according to the authors.

The revolution is under way, and the revolutionaries are likely to be found in the Authority Health teaching health center program, and other similar programs throughout the country.

Dennis Archambault is director of Public Affairs for Authority Health.