Harvard Business School, Cambridge, Massachusetts, USA.
Health Aff (Millwood). 2013 Mar;32(3):516-25. doi: 10.1377/hlthaff.2012.0961.
Primary care in the United States currently struggles to attract new physicians and to garner investments in infrastructure required to meet patients' needs. We believe that the absence of a robust overall strategy for the entire spectrum of primary care is a fundamental cause of these struggles. To address the absence of an overall strategy and vision for primary care, we offer a framework based on value for patients to sustain and improve primary care practice. First, primary care should be organized around subgroups of patients with similar needs. Second, team-based services should be provided to each patient subgroup over its full care cycle. Third, each patient's outcomes and true costs should be measured by subgroup as a routine part of care. Fourth, payment should be modified to bundle reimbursement for each subgroup and reward value improvement. Finally, primary care patient subgroup teams should be integrated with relevant specialty providers. We believe that redesigning primary care using this framework can improve the ability of primary care to play its essential role in the health care system.
美国的初级医疗保健目前面临吸引新医生和投资基础设施以满足患者需求的困难。我们认为，缺乏针对整个初级医疗保健领域的强有力的总体战略是这些困难的根本原因。为了解决缺乏整体战略和初级医疗保健愿景的问题，我们提供了一个基于患者价值的框架，以维持和改善初级医疗保健实践。首先，初级医疗保健应该围绕具有相似需求的患者亚群来组织。其次，应该为每个患者亚群提供团队式服务，贯穿其整个护理周期。第三，应该将每个患者的结果和实际成本作为护理的常规部分，按亚组进行衡量。第四，应该修改支付方式，为每个亚组捆绑报销，并奖励价值提升。最后，初级保健患者亚群团队应该与相关专科提供者整合。我们相信，使用这个框架重新设计初级保健可以提高初级保健在医疗保健系统中发挥其基本作用的能力。
