Primary Care as Healthcare Infrastructure

The need to rehabilitate American infrastructure such as roads, bridges, and water systems is well recognized. These services are used daily by millions and impact the economy, health, and commerce of America. Likewise, primary care needs rehabilitation, investment, and much more public policy attention. Patients with high cost chronic conditions are more likely to see a primary care physician than a specialist physician. 1 The complexity of these visits continues to be under recognized and undervalued, endangering the health of the patient and the economic health of this nation.

It has been ten years since Dr. Donald Berwick, former administrator of the Centers for Medicare and Medicaid services, promoted the concept of the Triple Aim, with obtainable goals of a) improving the patient healthcare experience, b) improving the health of the population writ large, and c) reducing costs. Local efforts have had some impact, although progress is uneven. Frameworks for achieving these objectives are still being implemented with more work to be done.3 Stressors on the primary care medical community are extremely high, with complexity of care for each patient typically exceeding that of many other specialties such as cardiology and psychiatry.2 Primary care is tasked with managing the multitude of chronic diseases encountered everyday in most patients on a background platform of prevention, wellness, and personal counseling. The addition of population health has all too often been met by adding to workload without adequate technologic tools or human resources, nor payment to accomplish these critical goals. Indeed, burnout across medicine has led to the newer use of the Quadruple Aim with a goal of d) improved work life balance in medicine careers.4

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