What if we thought of primary care clinics as important research labs?

THE IDEA: REVOLUTIONIZE THE WAY WE DELIVER PRIMARY CARE

Ten years ago, our primary care clinics were failing. We were running them separately from the rest of the health care system—and losing $20 million per year.

The loss was so deep and devastating that it was actually threatening the bond rating of the University. "We were a toxic asset," says Michael Magill, M.D., chair of the Department of Family and Preventive Medicine. "People were mad, scared and very worried about our group." That turned out to be the perfect environment for real innovation. With mounting financial and administrative headaches, the community clinics were restructured as a separate entity under the wing of University of Utah Hospitals and Clinics, while integrating all of their functional areas, from scheduling to marketing to billing, in a way that was needed to survive the crisis. And that's when the real experimentation began.

Taking a cue from innovation luminary Clayton Christensen and his theory of "Disruptive Innovation," the restructured clinics untethered themselves from organizational bureaucracy. This allowed them to rapidly create new models of management and patient care and envision all-new care delivery systems.

"We were a toxic asset. People were mad, scared and very worried about our group."

And so our community clinics became a powerful health services research lab, complete with wild ideas, new experiments, disappointing detours, unexpected discoveries and, ultimately, a new understanding of how to move forward. In the end, the guiding principles all came down to a single question: What does the patient want? By honestly exploring this question—and staying consistently focused on finding the answers—breakthroughs began to emerge. "We knew what changes had to be made, and we made them," says Robin M. Lloyd, M.P.A., executive director of University of Utah Health Care's Community Clinics. "We didn't ask permission."

Today, University of Utah Community Clinics have become a national model for patient-centered medical homes, a new approach that provides patients with a home base to coordinate all of their health care. The financial losses have been turned into profits, patient satisfaction scores have risen dramatically, and hospital administrators now come from all over the country to learn about our model and connect the dots at their own organizations.

"We're creating the kind of care that keeps people well and keeps costs down," says Magill. With health care costs rising faster than the national inflation rate and health care reform just around the corner, there's never been a better time for efficient, affordable and integrated primary care. "Primary care saves money by cutting the incidence of major health problems like heart disease or diabetes later in life," says Paul Grundy, M.D., adjunct professor in the Department of Family and Preventive Medicine. As the global director of health care transformation at IBM, Grundy is a major employer advocate for shifting health care delivery to patient-centered, primary care-based systems. IBM spends $2 billion a year for employee health care, and Grundy feels that far too much of that money flows to specialists for procedures instead of primary care doctors for prevention. "That's why we need a back-to-the-future approach to the family doctor, enabled by advanced information technology and innovative health services."

That is precisely what our newest community clinic, the South Jordan Health Center, aims to deliver.

We've designed the South Jordan Health Center to model a different kind of health care system–one that delivers better care at a lower cost; one that provides integrated, continuing care rather than just managing single episodes; one that's smarter, simpler and altogether better for the patients we serve.

"In truth, the current health care system isn't a system at all," says Grundy. "It's antiquated. It doesn't link diagnosis, drug discovery, health care deliverers or insurers. And it's expensive. Every year, personal health care expenses push more than 100 million people worldwide below the poverty line. Our current health care processes are simply not smart enough to be sustainable."

"In truth, the current health care system isn't a system at all. It's antiquated … and it's expensive."

But here's the challenge: The clinical arm of a typical academic medical center, such as University of Utah Health Care, generates 94 percent of its revenues from specialty care and only 3 percent from primary care. (The other 3 percent comes from emergency services.) So how could we afford not to focus on specialty care? For Paul Grundy, the answer will soon become obvious: If the value proposition you offer to employers and patients isn't competitive, quite simply, they'll take their business elsewhere.

"Our addiction to high-margin business is toxic, dangerous and wasteful," says Grundy. "I don't want to see five different specialists working independently on my employee with no one looking at the big picture. It's unethical and immoral to manage an episode of care only and not coordinate care for a patient."

So how will we get to the future?

Grundy, Lloyd, Magill and other health care visionaries firmly believe that the transformation of American medicine will revolve around patient-centered, community-based medical home clinics. "Someday, we're going to quit building ICUs and start building more South Jordans," says Lloyd. "This model is going to save the system." Grundy agrees. "Over the next couple of years, there will be winners and there will be losers. And though it may not be easy to see now, I believe we will see new leaders emerge who win not by surviving the storm, but by changing the game." In the meantime, we're continuing our research in our community clinic "labs."