title: The Coming Primary Care Revolution.
abstract: The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. Rising healthcare costs, high rates of waste, the continued trend towards chronic non-communicable disease, and the growth of new market entrants that compete with primary care services have set the stage for fundamental change in all of healthcare, driven by a revolution in primary care. We believe that the coming primary care revolution ought to be guided by the following design principles: 1) Payment must adequately support primary care and reward value, including non-visit-based care. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an ever-increasing role in most aspects of healthcare. 3) Generalist physicians will increasingly focus on high-acuity and high-complexity presentations, and primary care teams will increasingly manage conditions that specialists managed in the past. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training.
authors.affiliation: Center for Primary Care, Harvard Medical School, 635 Huntington Avenue, Boston, MA, 02115, USA.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ellner
authors.affiliation: Center for Primary Care, Harvard Medical School, 635 Huntington Avenue, Boston, MA, 02115, USA. Russell_Phillips@hms.harvard.edu.|Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. Russell_Phillips@hms.harvard.edu.
authors.forename: Russell S
authors.initials: RS
authors.lastname: Phillips
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration / Q000639:trends; D019317:Evidence-Based Medicine / Q000379:methods; D018166:Health Care Reform / Q000379:methods*; D006801:Humans; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration / Q000639:trends*; D014481:United States
keywords: care delivery innovation; health workforce; healthcare systems; primary care; value-based care