What is primary care and how can we encourage organizational power?

If we want to create an efficient healthcare system, we need to give primary healthcare a central role. Better cooperation within primary care and with other disciplines is undoubtedly necessary. But what is primary healthcare? And how can we realize this cooperation?

A visit to your general practitioner’s, social worker or child health clinic: we all have our experiences with primary care. We cannot underestimate its importance. The quality of primary healthcare is a make or break factor for primary healthcare. Research has concluded that primary care is the driving force of delivering value (better quality versus lower cost) in a healthcare system.

What is primary care?

Primary care is healthcare that is directly accessible. Patients can contact primary care providers directly. Unlike medical specialist; patients need a referral from primary care providers to access those. This is at least the case in countries with a strongly developed primary care system.

In day-to-day life, we tend to use primary care as a synonym for general practitioners (GP). But primary care is much more than that. Disciplines such as nursing care, physical therapy, social work, district nurses and psychological care are also primary care providers. It is true that a GP generally has a pivotal role, since he/she is the first person a patient will usually contact.

Even more important than which parties make up the primary care category, are the functions the system fulfills. Primary care must:

  1. 1. be accessible and approachable when it comes to health problems
  2. 2. offer a wide range of care services
  3. 3. constantly offer personalized care
  4. 4. guarantee the proper coordination of this care

In addition, the so-called ‘equity principle’ should be leading. In principle, everyone should have equal chances to be as healthy as possible.

What are the characteristics of primary care?

Primary healthcare has the following four characteristics:

  1. 1. Person-centered. The patient is at the center of a care provision. It is about his/her health in the context of his or her social environment.
  1. 2. Population-centered. A system of primary care strives for the best possible health of the population of citizens that it is responsible for.
  2. 3. Wide variety of services. Different disciplines within the system work together as efficiently as possible so they can offer the widest possible array of services together.
  3. 4. Gatekeeper role. Primary care is the door to medical specialist care. Patients that need more specialized care, are referred quickly and efficiently.

Lack of organizational power

The organizational power of primary care leaves something to be desired. Primary healthcare is organized according to the principles of a monodisciplinary small business, but it includes a wider range of disciplines. This means it cannot always fulfill the above characteristics. Despite the implementation of health centers, patient centered medical homes, accountable care organizations, care groups, the organizational power of primary care is still a weak spot. And it is just that organizational power that is necessary to ensure these four characteristics are fulfilled and to guarantee good, affordable care.

Cooperation in regional healthcare: questions and essential building blocks

To gain organizational power, you need more cooperation within a specific region or neighborhood. This leads to questions. What is needed for successful cooperation? Which parties should be involved? How do we design an effective cooperation? It is important to have a clear image of these questions and even more important: of the answers.

Which criteria does primary care need to meet to be considered well organized? I talked about this at length in an earlier blog. In short, these are the essential building blocks:

  • Leadership and management. Usually the best way to go is a combination of clinical and managerial leadership. Professionals from the field, like GPs and physiotherapists, know how things work within healthcare and that is why they are the perfect candidates to lead a well-functioning organizational network.
  • Data-driven performance management. This is already used in a lot of hospitals, but not so much in primary care. By collecting data, linking information systems and employing algorithms, we can make predictions about the demand for care within a specific region or neighborhood. The different parties in the region can use this information and respond appropriately.
  • Cooperation and shared responsibility. A multidisciplinary approach is, as previously mentioned, essential to deliver the core values of primary care.
  • Healthcare coordination. A prime characteristic of well-coordinated healthcare is active case management, accessible healthcare plans and regular multidisciplinary meetings.
  • Accessibility. Essential for patients as well as organizations. Healthcare should not only be accessible offline, there also needs to be a clear online system of e-Health applications, which organizations can use to design their healthcare approaches.

From theory to practice: Community Based Healthcare

From 1 January 2018, primary care providers in the Netherlands have received funds to further improve their regional organizational power to deliver Community Based Healthcare (CBH). This type of funding is called Organization & Infrastructure. However, previous programs learned us that we need more than just money. Different care providers within a region or neighborhood need to know where to find each other and agree on the terms how to deliver collaboratively Community Based Healthcare (CBH) services.

For Community Based Healthcare (CBH) services in the Netherlands we distinguish between four parties:

  • Primary Care Organizations
  • Health Insurers Companies
  • Local Hospitals
  • Municipalities

If these parties do a better job at cooperating, this protects the common interest: the right type of care for the patient in the right place.

What should this cooperation look like? That is dependent on a number of factors. These could be demographic or regional factors. The process of setting up Community Based Healthcare like this based on the key characteristics of a primary care approach that delivers real value is made up of six steps. You can find these steps in the whitepaper Value-based healthcare: a call for integrated action by Essenburgh Research & Consultancy, which you can download here.

Masterclass Working Together Towards Value-based Healthcare

As we have mentioned: there is a lot to be gained when it comes to cooperations within primary healthcare. This does mean we need to overcome a number of obstacles. That is why Essenburgh Research & Consultancy is organizing the Masterclass Collaborating on Value-Based Healthcare. During this masterclass, you will learn to recognize and overcome obstacles for cooperation within your organization and with other organizations. The masterclass is meant for managers, directors and other healthcare professionals. For more information, click the banner to see the brochure.

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dr. Pim Valentijn

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