Fixing: Continuity and "a throne of lies?"

If you've been scrolling through LinkedIn lately, you might get the impression that healthcare is heading towards a more fragmented future, with a big focus on quick access and patient convenience. But let’s cut through the hype for a second – this isn't the whole story. This approach isn't necessarily going to save money, nor is it the golden standard of care we remember from a decade ago.

Let's pause and look a little closer. The key to cost-saving and improving health outcomes doesn't lie solely in catchy phrases or instant solutions. I've compiled a shortlist of examples that break down what's genuinely working in healthcare today. These aren't just success stories; they're blueprints for a sustainable and effective future in healthcare, blending the best of innovation with the wisdom of tried-and-true practices.

Medicare savings grew as continuity of care increased, but the savings were only positive for those patients in the high-continuity groups. Continuity was so important that patients with highly continuous care experienced savings no matter which frequency or regularity group they fell into—but for patients at any particular level of continuity, savings were highest for those who received regular care too. Cited here.

These findings suggest that having regular primary care visits with the same clinician is strongly associated with Medicare savings, an association that is optimized at greater visit frequencies for patients of higher complexity. Cited here

Whereas a wide range of indicators is used to measure COC (continuity of care) in claims-based data, associations between COC and healthcare use and costs were consistent, showing lower healthcare use and costs with higher COC. Results were observed in various population groups from multiple countries and settings. Further research is needed to make stronger causal claims. Cited here

And for children : Continuity may improve care quality and prevent high-cost health encounters, especially for children with chronic conditions. Novel solutions are needed to improve continuity in the medical home. Cited here

Now, take a moment to glance at the graphic we've shared above. Back in 2015, this represented the continuum of care as envisioned by the American Hospital Association . Notice how 'primary' extends across the full spectrum? It's pretty eye-opening.

And hold on, before you do a double-take – let’s unpack the guiding principles that were put forward at the time.**

“Workforce Roles in a Redesigned Primary Care Model”

1. In partnership with the patient, the primary health care team is guided by what is best, needed and helpful to the patient and family.

2. The workforce must change how it functions on multiple levels. Care must be provided by interprofessional teams where work is role-based, not task-based, and the team must be empowered to create effective approaches for delivering care.

3. Hospitals can serve as conveners and enablers in primary care delivery. Primary care should be integrated into current and future care systems, and hospitals should form effective partnerships with the community and patients in a way that provides the infrastructure primary care teams need to deliver quality care.

Have you ever stopped to consider the irony in today’s healthcare landscape? Hospitals, health systems, and investors often chase the latest trends, yet they sometimes overlook the proven fundamentals. The top three elements that genuinely enhance healthcare and drive down costs? Continuity, continuity, continuity.

But let's spread the scrutiny evenly. Primary care, for its part, has seen significant shifts in the past decade. Has it embraced the concept of increased continuity? It seems the trend has been towards more urgent care, more referrals to emergency departments and specialists, less hospital rounding by primary care physicians, and a disconnect in post-discharge follow-ups. And now, the emerging 'hospital at home' models are often led by hospitals, not primary care practitioners.

Where does this leave the concept of team-based care? Or the strategic use of technology to foster continuous patient engagement? Are virtual check-ins and patient navigators being implemented as they could be to drive better care? It appears that much of our effort and resources are being directed towards disrupting this continuum rather than supporting it. This disconnect might explain why some 'innovative' strategies lead to increased revenue without improving outcomes – because, perhaps unintentionally, that's the outcome they've been designed to achieve.

It prompts the question: Are we focusing on the right things? Are we leaning into the things that we have espoused in the past and really know that work?

Here’s the lesson: Real savings and quality care come from continuity. More interactions with primary care, more frequent touchpoints – that’s the formula for reducing costs and improving patient health. Understanding this could be a turning point if we genuinely commit to redefining 'better' healthcare.

Do we sit on a throne of lies? Haha.. or hohoho.. great clip. Of course, I think primary care like Santa are real.. maybe we all should?

Note:?As a reminder this newsletter is written from my experience and perspective.?The newsletter does not imply or relay the opinions of others.??The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective.??I am a physician and so can only write from my perspective.?If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree.?I have no intention to suggest or imply that only the physician perspectives matter.??They do matter but as part of a larger dialogue that can foster better health outcomes. Edited with ChatGPT

additional references.

.https://www.medicaleconomics.com/view/primary-care-continuity-can-lower-health-care-costs-study-finds

https://www.shepscenter.unc.edu/wp-content/uploads/2014/09/HWTACwebinar3_Fraher_9Apr2014.pdf