Research

Transforming primary care and health care systems to meet 21st century societal needs and patient expectations will require bold vision and unprecedented execution. Managing change, bending the cost curve, and caring for an aging population are among the many pressing demands on practices and systems that call for radically new approaches to teamwork, culture, financing, and use of information technology. While primary care leaders and practices have been chronicled in many venues, including online, the popular press and academic publications, readers are typically limited to learning what these leaders or practices are doing, not how. The Harvard Medical School Center for Primary Care seeks to fill a critical knowledge gap by profiling exemplar practices, systems, and models both domestically and internationally, and by addressing how they operate and defy current systemic challenges in order to deliver high-performing primary care services. (more…)

Education

Education: The Center is working to transform primary care education at Harvard and beyond. We are working closely with the HMS Program in Medical Education to develop a new foundational curriculum that for the first time will include a longitudinal primary care practicum for the development of clinical skills at Harvard Medical School, as well as developmental curriculum in primary care that will span all four years of medical school.

Primary Care Practice Policy Model

The Primary Care Practice Model is a stochastic simulation model that estimates how practice financial performance varies depending on six variable inputs:

• numbers of practice staff of various types (ex. clerical staff, physician assistants, community health workers etc.),
• salaries and benefits for all practice employees,
• overhead expenditures including physical infrastructure and service-related expenses such as EMR expenses,
• patient characteristics including age, sex, race/ethnicity, income, insurance type if any, and ICD diagnoses as available
• patient volume per physician day and/or number of appointment slots available per day,
• typical billing rates per physician
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Reflections on Southcentral Foundation’s 2014 Nuka Conference

Preparing for the 2014 Nuka Conference, I read all I could before heading to Anchorage, Alaska. I knew that Southcentral Foundation (SCF) invests heavily in primary care delivery; that their system is owned by the Alaska Native people; and that their system emphasizes “building relationships” with their patients (known as “customer-owners”), a concept that was new to me. I learned that SCF staff view patients as customers because their services are tailored to the needs of the population to ensure a positive, engaging experience. Patients are owners in the sense that as Alaska Native people, they own their health system through a legislative framework created and developed over the last thirty years through major advocacy work with the US federal government. Even after reading all I could, I soon found that simply experiencing the conference would be pivotal in my understanding of SCF and their approach to delivering healthcare. (more…)

A Visit to Gold Direct Care: Massachusetts’ First Direct Primary Care Practice

In the Center’s quest to learn more about the direct primary care (DPC) model and movement, four members from the Center’s team traveled to Marblehead, MA in early August to visit Gold Direct Care.  Gold Direct Care is located in the heart of downtown Marblehead, in a beautiful building with a quaint courtyard. The office was thoughtfully designed; the front room was saturated with natural light and the waiting area looked more like a modest living room instead of a doctor’s waiting room. Megan, the practice’s nurse, one of three employees, immediately greeted us as we entered, and led us back to Dr. Gold’s office. (more…)

Designing Primary Care in the Netherlands: Almere and Nieuwegein

In mid-late April, two main events take hold of the Netherlands—the tulip blooming season and King’s Day (formerly Queen’s Day). The Dutch are famous worldwide for their never-ending, colorful fields of tulips that paint the countryside, and the king’s birthday boasts the year’s biggest street party filled with live music, open markets, and crowds of orange. During this period, the Center’s Research Team joined the hordes of tourists visiting the Netherlands, but on a different mission: to conduct fieldwork for their third installment of the Primary Care Systems Case Collection. (more…)

Martin’s Point Health Care – Bangor

Last March, the Center’s research team traveled to Bangor, Maine—only a couple hours drive from the post-blizzard world of Boston. We were visiting the Bangor practice of Martin’s Point Health Care (MPHC), in preparation to write the next case study in our Primary Care Systems Case Collection series. MPHC-Bangor has been lauded for their innovative practice, high-performing workforce model, and high workforce satisfaction levels by the Institute of Medicine, the Robert Wood Johnson Foundation, and the ABIM Foundation, respectively. The buzz generated by this kind of recognition got us excited, and throughout our site visit, it was clear in the interactions that this practice valued both their staff and patients. (more…)

City Invincible: A Visit to the Camden Coalition of Healthcare Providers (CCHP)

In June, the Center’s Research Team visited CCHP, the subject of the fourth installment of the Primary Care Systems Case Collection (Center for Primary Care Case Studies). Since their inception in 2006, CCHP has been at the forefront of care management for complex patients. Over the years they have built a network of community partners, an innovative super-utilizer intervention, and a robust business model to deliver quality care at lower costs – all of which sparked the Center’s interest. At the end of our visit, we were able to attend the monthly staff meeting in the assembly room, which, that Friday morning, was overflowing. CCHP has been pressed for space; the rapid increase in staff over the past few years meant monthly meetings are more necessary- and more crowded (more…)

Patient Provider Relationships Lead to Better Health Outcomes

This article originally appeared in Harvard Business Review

Center Co-Director, Andy Ellner, and Director of Research and Curriculum, Erin Sullivan, recently co-authored an article that explores the effect patient-provider relationships on better health outcomes. The article highlights key findings from studies of exemplary primary care organizations, which are part of a cased-based series.

“The leaders of these practices all believe that by promoting relationship building on an individual patient level, favorable costs and outcomes will follow. Here’s a brief account of what we found…”

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