2017
DOI: 10.1007/s11606-016-3945-2
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Disruptive Models in Primary Care: Caring for High-Needs, High-Cost Populations

Abstract: Starfield and colleagues have suggested four overarching attributes of good primary care: Bfirst-contact access for each need; long-term person-(not disease) focused care; comprehensive care for most health needs; and coordinated care when it must be sought elsewhere.^As this series on reinventing primary care highlights, there is a compelling need for new care delivery models that would advance these objectives. This need is particularly urgent for highneeds, high-cost (HNHC) populations. By definition, HNHC … Show more

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Cited by 63 publications
(65 citation statements)
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“…Primary care is credited for better population health, more health equity and better use of resources (Starfield, ). Four key domains are associated with high‐quality primary care: first‐contact access for each need, person focused (not disease) over time, comprehensiveness and coordination of care (Hochman & Asch, ). Vulnerable populations benefit most from quality primary care (Starfield, ) and family caregivers are a vulnerable population (Centers for Disease Control [CDC], ).…”
Section: Introductionmentioning
confidence: 99%
“…Primary care is credited for better population health, more health equity and better use of resources (Starfield, ). Four key domains are associated with high‐quality primary care: first‐contact access for each need, person focused (not disease) over time, comprehensiveness and coordination of care (Hochman & Asch, ). Vulnerable populations benefit most from quality primary care (Starfield, ) and family caregivers are a vulnerable population (Centers for Disease Control [CDC], ).…”
Section: Introductionmentioning
confidence: 99%
“…17,18 The findings of a cost-neutral program at the conclusion of the pilot are not surprising given the resource investments, and failure to find cost savings is a known possible consequence in similar programs. 13,19 …”
Section: Discussionmentioning
confidence: 99%
“…11,12 Some, though far from all, programs have demonstrated cost savings for this population. 13 Despite lack of consensus about best practices, the ubiquity of team-based comprehensive care has brought requests for graduate medical education to emphasize related experiences for trainees. 14 …”
Section: Introductionmentioning
confidence: 99%
“…1 Unfortunately, however, complex case management has shown only modest benefits in rigorous evaluations. 1 Nevertheless, research has begun to shed light on which approaches to complex case management offer the most promise.…”
mentioning
confidence: 99%
“…1 Unfortunately, however, complex case management has shown only modest benefits in rigorous evaluations. 1 Nevertheless, research has begun to shed light on which approaches to complex case management offer the most promise. Specifically, the most effective programs seem to involve close, interpersonal interaction among care coordinators, patients, and primary care clinicians; a focus on care transitions; a component of medication management; and the targeting of patients amenable to intervention, such as the frail elderly.…”
mentioning
confidence: 99%