The Future of Primary Care

If recent news headlines are any indication, primary care is at a crossroads. A combination of rising health care costs, antiquated care models, increased patient demand, and an anticipated shortage of physicians has stressed existing systems, creating what many refer to as a “primary care crisis.”

In the face of this grim picture, health care providers are rethinking the primary care paradigm, coming up with new, innovative ways to deliver care and improve patient experiences. Stanford has been at the forefront of this movement, working to transform and revitalize the field.

Primary Care 2.0

Imagine a place where your health care is tailored to your lifestyle. Your minor medical issues can be handled remotely, your physician works with a multi-disciplinary team, and your care is continuous, affordable, and preventive. That’s the idea behind “Primary Care 2.0,” a new Stanford initiative dedicated to providing high-value patient care.

“Primary Care 2.0 aims to rethink and transform the way we practice,” says Megan Mahoney, MD (clinical associate professor, General Medical Disciplines).“Today’s primary care field is somewhat broken; patients feel that they don’t get to spend enough time with their provider and that physicians are less focused on wellness and prevention.”

The current system also puts a strain on providers. As Mahoney explains, “Providers feel very burnt out. Primary Care 2.0 has given us the chance to ask: How do we increase the value of what we’re doing?”

Primary Care 2.0 is a blueprint for the future. It builds on Stanford’s commitment to excellence in patient care while improving coordination of care, access to services, and patient experience. “It’s more than a system, it’s a new way of operating,” says Mahoney. “It’s flexible, so patients will be able to access us how they choose; it’s proactive, so we’ll be reaching out to patients between visits; and it’s designed to ensure continuity.”

Today, a team of physicians, designers, pharmacists, and others are working to bring this blueprint to life. The team is planning a clinic demonstration site that will be intuitively designed to incorporate the principles of the Primary Care 2.0 model. “For example, if a patient came in for a visit and they wanted to sign up for MyHealth—Stanford’s web-based health management platform—we would have a tablet in reception for them to sign up, as well as a video that would walk them through the process. As soon as they registered, their information would be sent to their care team.” Once the demonstration site opens, the Primary Care 2.0 team will continue to iterate their new model. “We’ll be learning from our clinic,” says Mahoney, “and we’ll be able to improve and perfect what we’re doing.”

ClickWell Care

ClickWell Care, a new virtual online clinic staffed by Stanford physicians, is another innovation designed to upend the traditional primary care model. Armed with a laptop or a cell phone, patients who are enrolled in the ClickWell program can choose to meet with their doctors virtually, without having to take time out of their day to travel to a clinic. Or they can opt to meet their clinician in person. “ClickWell leverages technology to make care more accessible and convenient,” explains Sumbul Desai, MD (clinical assistant professor, General Medical Disciplines). “We empower patients to connect with us in the way they see fit.”

So far, the program seems to be working. “We’ve had really good traction, and a lot of return business. About 90–95% of patients who start with ClickWell stay with ClickWell.” Providers have also expressed enthusiasm. “The mix of in-person, phone, and video seems to create less burnout for physicians. They find that it’s a nice way to interact with their patients,” says Desai.

Another aspect of ClickWell that has been well received is the virtual wellness coaching. Wellness coaches—usually fitness trainers and nutritionists—can work with patients to help them meet specific health goals, like losing weight or training for a marathon. They’re also an integrated part of the patient’s care team, and they work closely with the primary physician. “Patients can see a wellness coach as frequently as they want,” says Desai, “and they’re really able to see the coach as a partner in their overall health.”

Inspired by their recent success, the ClickWell team is now working to expand their program. “Going forward, we’ll continue to test and tweak the model with larger patient populations.”