Viewpoint

Primary Care in the Consumer-Centric Era


Sasha Preble
Optum
Nate Comstock
Optum
Bergen Schoenfeld
Optum

Primary care has long anchored our care delivery system, although its role and purpose keeps changing. During the heyday of the HMO era, it served as a utilization gatekeeper. More recently, primary care has served as the proverbial glue that binds patient information and clinical relationships for individuals with diverse medical needs. Or a friendly face to help us feel better when we have a sore throat.

We’re pivoting to an era in American health care that is characterized by the need to manage the total cost of care while putting customers (even before they become patients) at the center of our planning, design, and execution. That places primary care at a fork in the road. And, as Yogi Berra might have said, we should take the fork.

A 2017 Kaiser Family Foundation study found that 28% of men and 17% of women in the United States are not actively managed by a primary care provider. There are any number of reasons for this, ranging from the shortage of primary care physicians to the lack of perceived value in longstanding physician relationships.

But the important role primary care plays still applies. We need to minimize the gap between customer needs and expectations and the value generated by primary care. Cue customer segmentation. Research suggests that there is not one approach to the provision of primary care. Whether it be the access model, convenience characteristics, or the provider itself, different consumer segments want and expect different things. Using a consumer-centric framework suggests meeting consumers where they are with service offerings that align with their expectations.

To that end, consider these three different models for primary care:

  • Access and convenience. For consumers who want a relationship with a provider (or group of providers) and expect a higher level of service, this model focuses on improved access and convenience, team-based staffing models with providers across levels, online scheduling, and digital connectivity.
  • Care for the chronically ill. This model is more clinically intensive and includes diverse care team members (e.g., clinicians, dietitians, social workers, pharmacists), structured workflows across providers, and focused patient engagement efforts to make it easier for the sickest patients to get the regular care they need.
  • On-demand episodic care. Recognizing there are consumers who will not engage in traditional delivery models or even seek out a primary care relationship, there is still an episodic access need. This need can be addressed through any number of care settings and virtual channels.

Each of these models comes with different assumptions about staffing, workflows, physical and virtual infrastructure needs, provider relationships, payment models, and patient communication and activation strategies. Many organizations must consider providing all three options if they are going to serve their diverse communities. Regardless of the models chosen, every organization needs to think through its primary care strategy. It must know who its consumers are and their unique preferences. It must be intentional about whom it is targeting and develop a focused strategy. And it needs to anticipate changing government regulations and programs. The solution set will hinge on a number of factors including: target customer segments, competitive presence, and overall strategic aims. Ultimately, we need to get back to basics of the role primary care providers play in their communities—healing the sick and keeping people well. While the means may vary based on consumer needs, returning to your purpose and putting customers at the center will put delivery organizations on the critical path to success.

Sasha Preble is a partner; Nate Comstock, a manager; and Bergen Schoenfeld, an analyst, all at Optum.