Redesigning Care Because of Health Care Reform


This blog post is the second in the Supply, Demand and Medicine series on health care reform.

In the first of our Supply, Demand and Medicine series, we looked at some of the challenges facing the health care industry, particularly related to the number of physicians who will care for the newly insured and our aging population.

While there has been an increase in the number of medical students, there are other ideas, considerations and models of care that will also be critical in helping meet future demand for health care.

It’s important to keep in mind that many projections regarding the physician shortage are based on recommendations from the Department of Health and Human Services made in the 1990s, which recommends 60-80 primary care physicians and 85-105 specialists per 100,000 in population.

Since then, Baylor Quality Alliance, a division of Baylor Scott & White Health and many others from around the nation have been working on developing new concepts and efficiencies as solutions to meet demand while still delivering high quality care, including:

1.  Patient-Centered Medical Homes


There is increasingly a move towards team-based medicine and patient-centered medical homes (PCMH). Endorsed by the American Academy of Family Physicians and many of the nation’s most prestigious medical organizations, a PCMH is an expanded physician practice, usually a primary care practice.

In a PCMH, a physician is the head of a team that may include physician assistants, nurse practitioners, pharmacists, and sometimes even social workers and health coaches working together to provide care.

The physician plays the role of both doctor and manger, allowing other clinicians to treat minor/routine medical issues, while he or she focuses on more complicated cases.

Under standard models of care, a primary care physician may only be able to care for 2,000-2,200 patients annually, whereas with a PCMH, the physician could care for up to 4,000 patients, all without a drop off in quality.

In North Texas, the Baylor Quality Alliance, an organization of physician practices committed to delivering high quality, evidence-based health care as efficiently as possible–already has more than 325 primary care physicians that are part of registered PCMHs.

2.  Emerging Concepts of Care

Traditionally, patients in need of routine care for minor illnesses or certain health conditions had to schedule an appointment with their physician who may be located across town or booked solid for weeks. Retail clinics and pharmacies are expanding the health services they provide.

For example, Walmart has stated that they intend to become the largest provider of primary care in the world. Another of the nation’s top pharmacy chains has announced an aggressive chronic disease management program with the intention of adding thousands of clinics to their stores to provide ongoing care to certain patient population.

These clinics would offer access to preventative and chronic care closer to home, along with expanded hours of operation at a lower cost.

Walgreens and CVS are rapidly adding mid-level staffed clinics to their retail pharmacies.

Will these convenience clinics be disruptive to traditional models? Certainly. But consumers are already supporting convenient access for low acuity problems.

3.  Redesigning care for those who need it most

In any population of patients 5% of those patients consume 50% or more of the total cost of care. Identifying those patients, who have multiple co-morbidities, is crucial.

Once identified, extra resources can be deployed, such as RN case managers, to assist these complex patients in care coordination and disease management.

Such initiatives are already proving helpful in both raising quality and reducing overall cost.

4.  Innovative Technology

House calls may be making a comeback, 21st century style. There are many technologies companies working on solutions to allow for online physician e-visits or virtual visits.

Patients from the comfort of their own home computer, or through a mobile device app, will be able to have a video chat with their physician.

Physicians can collect information from their patient, such as weight, blood pressure and any symptoms they are experiencing, then make a decision on adjusting medications, diet, or otherwise alter their care plan.

Virtual visits would not only be much more convenient for patients, but also offer physicians greater flexibility.

What’s more, this technology is not just for the young. One technology developer I’ve spoken to says that 25 percent of their users are over the age of 60.

Meeting the growing demand for quality health care is one of the most complex challenges facing society. It’s going to take some big ideas, many of which are already out there.

Undoubtedly there are many more to come, which is why so many of us in health care are excited about being involved in redesigning the future of medicine in this country.

About the author

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Dr. Couch currently serves as President of the Baylor Scott & White Quality Alliance, an integrated network of more than 3,700 physicians, 43 hospitals, 31 surgery centers, 29 skilled nursing facilities, 10 home health agencies, three hospices and additional points of care aligned with Baylor Scott & White Health.

1 thought on “Redesigning Care Because of Health Care Reform”

  1. Cutting Cost in Health Care is a major push. I have a friend that works at the Women Hospital in Fort Worth. Cutting Staff hours seems to be one way to accomplish the goal. I can understand that. The management has left several supervisor positions open putting more work load on staff. You have a very tough decision balancing act going on. Staff is treated poorly, taking call 3 to 4 nights per week and burn out, does not seem to be an issue management cares to deal with. Staff turn over has been an issue and that does affect patient care in the big picture.

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Redesigning Care Because of Health Care Reform