Madison, Wisconsin – A research team at the University of Wisconsin School of Medicine and Public Health discovered that an overhaul of the primary care system at the UW Health academic health center resulted in increased patient satisfaction, improved clinical safety metrics and publicly reported preventive-care outcomes.

Their newly published study suggests that the UW Health experience could be useful for other academic health centers planning to redesign primary care.

The four-year effort to switch to a population-based model came after UW Health discovered in 2007 marked variability between clinics and among providers and that metrics were below expected standards. At the same time, primary-care providers were leaving and a survey revealed concerns about the adequacy of clinical support staff.

The researchers reviewed the process of UW Health’s primary care transformation, which included family medicine and community health, general pediatrics and adolescent medicine and internal medicine. The goal of the redesign was to achieve the “triple aim” of better patient care, improved population health and reduced costs.

“One of the keys was development of a united primary-care leadership team that bridged individual departments to create and adopt a common vision and solutions to shared problems,” said lead author Dr. Steven Koslov of the Department of Pediatrics.

The leadership team identified five areas to align in the primary-care redesign:

  • Panel size definition
  • Development of a common primary-care job description
  • Primary-care compensation plan redesign
  • Care model overhaul
  • Standardized staffing development

Panel Size

Researchers said the number of patients in a panel is not an accurate reflection of work. As a result, they developed a weighting system for patients who have seen a primary-care provider over the last three years. The weighting factors are age, sex and payer type.

Develop a Common Primary-Care Job Description

The challenge was to create a standard job description across three departments: family medicine, general pediatrics and adolescent medicine and internal medicine. The job description is a clear, consistent definition of work expected of a full-time physician. It details clinical work expectations but provides flexibility to reflect specific responsibilities for each specialty. Job descriptions for medical assistants and nurses were also standardized.

Primary-Care Compensation Plan

The new compensation plan replaced one solely based on volume. It takes into account weighted panel size, work metric and “citizenship” requirements like department or divisional meetings and presentations. The pool of dollars is distributed to clinics and then is divided among physicians based on the three components.

Care Model Retooling

The leadership team standardized processes of scheduling, pre-visit planning, check-in, face-to-face visit, post-visit and medical management between office visits.

Standardized Staffing

For each primary-care specialty, the time required to complete a task was measured. The team considered the number of times the task was performed each day of the week. The calculations were then used to determine staffing for each primary-care specialty.

“We have constructed a model that incorporates a plan for integrating primary-care departments in an academic environment that is responsive to national changes,” said Koslov. “Our early outcomes indicate that these changes will allow us to provide patient-centered and high-quality care.”

Patient satisfaction went from 85 percent to 87 percent after changes were made to the primary-care system. In addition, anticoagulation measurement jumped from 65 percent to 75 percent and colorectal cancer screening increased by 11 percentage points from 69 percent to 80 percent.

“The collaboration across primary-care departments allowed us to more easily identify unwanted variation, become acknowledged leaders of change within the academic health center, garner more resources and enhance the status of primary care within the organization,” said Koslov.

The study (Across the divide: “Primary care departments working together to redesign care to achieve the Triple Aim”) was published in the Journal of Delivery Science and Innovation.

Published: March 2016

Study authors are members of the UW Health Primary Care Academics Transforming Healthcare (PATH) collaborative (https://hip.wisc.edu/PATH), a multidisciplinary coalition of physicians and change leaders who aim to bridge primary care clinical transformation and rigorous scientific study in order to improve our health system for the benefit of patients and communities.