We are constantly put in situations where we need to explain how the Crossover care model compares with others. We spend alot of time explaining to clients and consultants why it it makes no sense to compare a transactional urgent care “visit” to a comprehensive, integrated, proactive, and continuous care model. We also spend time explaining the role of primary care relative to care navigators, point solutions, virtual versus in-person care in the context of hybrid care, and all the various digital health vendors trying to solve for “last mile care”. Can all of these different configurations and conflagrations actually be considered world-class primary care?
While everyone can and should be searching for the right set of solutions to address the many systemic challenges, at the end of the day, someone still needs to actually DELIVER the primary care. And it would be GREAT if it were, in fact, world-class. Fortunately, world-class Primary Care was clearly defined by NASEM in 2021 with the release of its epic tome “Implementing High Quality Primary Care”:
- World-class primary care is “the provision of whole-person, integrated, accessible, and equitable healthcare by interprofessional teams that are accountable for addressing the majority of an individual’s health and wellness needs across settings and through sustained relationships [my emphasis] with patients, families, and communities.” (National Academy of Engineering, Science, and Medicine Consensus Study Report on Implementing High-Quality Primary Care (“IHQPC”), pg 46 ).
- World-class primary care is “the only component of healthcare where an increase in supply is associated with better population health and more equitable outcomes.” (IHQPC, pg 48-49).
- World-class primary care has a “demonstrated and superior capacity among healthcare services to improve population health and health equity for all society. It should not be viewed as another “commodity service whose value needs to be demonstrated in a competitive marketplace but rather as a Common Good to be promoted by responsible public policy and supported by private sector action.” (IHQPC, pg 373).
- World-class primary care “remains the largest platform for continuous, person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities and whose value is demonstrated with markedly stable usage patterns for more than 50 years (Green et al., 2001; Johansen et al., 2016; White et al, 1961).
I will continue to beat the drum, alongside so many others, to urge the healthcare industry, employers, and payers to raise the bar on their expectations of what foundational Primary Care can do and of what “world-class” should be.
- World-class primary care can NOT (by definition – see above) be the provision of services that are delivered by navigators, intermediaries, or others who don’t actually provide care. It must be hands-on, relationship-based, and continuous over time. Care delivery is where the magic happens, where the proverbial “value” rubber hits the “proof of ROI” road, where meaningful relationships are forged, where anxieties are calmed, tears are shed (and wiped away), and where real care happens.
- World-class primary care has been demonstrated time and time again, study after study, painstakingly, for more than 20 years in every possible forum and yet somehow we still are wondering if it will work, if it can be implemented, or should we be looking for alternatives.
- World-class primary care is being delivered by next generation companies like Crossover, Marathon, ChenMed, Devoted, Cityblock, Oak Street, and several others. These are hand-to-hand, arm-in-arm primary care companies that are “all in” on actual care delivery under a wide variety of true value-based arrangements.
World-class primary care is a known care model. It has been implemented in multiple settings and, as the evidence has repeatedly shown, it delivers results in ways that piecemeal “innovations” do not. Wherever you find it, it should be celebrated, encouraged, promoted, recognized and–most importantly–implemented. We need to collectively ensure world-class primary care — health as it should be — can be readily available everywhere in the future!
Scott Shreeve, MD 