Fifteen years ago, I helped found an experimental primary care clinic for the sickest Atlantic City casino workers through AtlantiCare. Many were suffering from chronic conditions and diseases and were frequently hospitalized. They were fed up with the lack of progress they were making with their personal health and wellness. Their union’s health fund, which was in dire financial straits following years of explosive medical costs, was searching for a solution.
Our idea, at its core, was simple: by focusing intensely on primary care services and assigning health coaches to work closely with our patients on their health goals, we could simultaneously improve their general wellbeing and reduce high healthcare costs associated with hospitalizations and the overuse of specialty care.
One year into our experiment, we saw marked success. We cut emergency room visits and hospitalizations for casino workers by more than 40 percent, helped 63 percent of smokers with heart and lung disease put down cigarettes for good, and lowered cholesterol among those with cardiovascular disease by an average of 55 points. For the casino workers’ union, several thousand people, we cut healthcare costs by 25 percent.
Our approach in Atlantic City, and a similar experiment in Camden, New Jersey, proved that a renewed focus on primary care can make a marked impact on the life of anyone struggling with chronic conditions. Despite the continued success of the clinic, primary care is still vastly underutilized in the healthcare system at large; many people only see their primary care practitioner once a year for an annual wellness visit.
A high-touch take on primary care promises to transform the health and wellbeing of anyone struggling with complex conditions — especially older adults.
The role of primary care has begun to fade
Most adults 65 and older are managing multiple chronic conditions like hypertension, diabetes and arthritis. When these conditions flare and impact function, or when they become unmanageable and cause constant pain, patients have a tendency to seek care from clinicians trained in a specific disease.
Without a primary care practitioner involved in care, many clinicians, like endocrinologists, cardiologists and rheumatologists, can become a main source of healthcare services. This is the case for a shocking amount of Americans. According to a study from the Archives of Internal Medicine, approximately two in five adults in the United States receive general care — services they should be receiving from a primary care practitioner — from a specialist.
This trend has had disastrous outcomes: Older adults who use a specialist as their main doctor experience less care coordination, spend more on healthcare and are hospitalized more frequently. Many of my former patients in Atlantic City experienced the downsides of the lack of primary care before they started coming to the clinic.
One of the clinic’s patients, for example, had experienced a minor inflammatory condition two decades before her first visit with our primary care clinic. We learned she had been visiting a cardiologist every three months since the incident to receive electrocardiograms — a test used to evaluate the heart’s rhythm and electrical activity — even though her results routinely came back normal. Despite getting lots of care, she was not seeing progress in her actual health — until her primary care team helped her put the pieces together and make concrete changes to her treatment and health.
This is not an uncommon experience for people over the age of 65, either. It is all too easy to get lost in the maze of the healthcare system without a primary care practitioner to coordinate care across specialties, and to help people understand how their conditions impact their whole-person health.
Seek great primary care as you age
As we grow older and our healthcare needs change, we naturally have a need to see more specialists. When we begin seeing several specialists, having a primary care practitioner as an anchor in our care becomes even more important.
As a primary care practitioner, I’m responsible for treating every part of my patients’ health as they progress along their personal healthcare journey. Beyond preventive health, that includes helping them manage their conditions and the medications they take to stay healthy, ensuring they understand what is happening with their care and helping them navigate the healthcare system.
I answer any questions they may have about their health and wellbeing, and make sure they have what they need to live and age well — and with dignity. As primary care practitioners, our primary role is to be a partner along the healthcare and aging journey, to understand our patients’ needs — clinically and emotionally — and manage their care accordingly.
Studies have found that the availability of primary care physicians in a given area is significantly related to better health outcomes, lower mortality rates and longer life expectancy for patients in that area.
Great primary care is comprehensive, continuous and coordinated. These are critical features that ultimately lead to a longer, healthier, happier life. According to a study published in JAMA Internal Medicine, Americans with primary care have a better patient experience, report improved overall access to care and receive significantly more high-value healthcare.
The involvement of a primary care practitioner lets recommendations and treatment plans stay on track. For years, studies have found that the availability of primary care physicians in a given area is significantly related to better health outcomes, lower mortality rates and longer life expectancy for patients in that area.
Today, access to convenient — and vital — primary care services has expanded beyond an experiment in Atlantic City. A new generation of innovative primary care companies are using virtual and in-home services to provide high-quality, immediate, and personalized care to older adults. Through frequent digital and in-person touchpoints, primary care practitioners like me have an opportunity to truly get to know the people we treat, to understand the way they live, the way they want to live, and to work with them to get there. That intimacy, fueled simply by availability, is key to putting the lessons we’ve learned in Atlantic City into practice elsewhere — especially here in Philadelphia County, which is home to over 221,000 adults 65 and older.
When an older adult has a strong, trusting relationship with a primary care team focused on their whole health, we find opportunities to identify concerns before they become emergencies, coordinate care with multiple providers and reduce the stress and trauma that can occur from repeated interactions with a complex healthcare system. We see patients not just getting care, but making care plans and seeing their health actually improve.
Dr. Neil Patel is a practicing doctor and the chief health officer for Philadelphia-based Patina, which provides in-home and virtual primary care for adults 65+.
The Citizen welcomes guest commentary from community members who stipulate to the best of their ability that it is fact-based and non-defamatory.
