The fundamental goal of health care is to improve the health of the public. Abundant
evidence indicates that health care systems built on a solid foundation of primary care are
best able to achieve this goal. Systems that invest in a strong primary care infrastructure
deliver more effective, efficient, and equitable care than systems that fail to invest adequately
in primary care.
Primary care is endangered in the United States, and confronts major challenges worldwide.
Manifestations of this predicament include clinical performance in primary care that falls
well short of achieving the desired outcomes, primary care clinicians afflicted with the“hamster syndrome” of working harder and harder without gaining ground, and declining
numbers of US medical school graduates electing careers in primary care.
In the US, primary care faces both external and internal threats. The chief external threats
consist of the failure to invest an adequate share of the nation’s health care resources in
primary care and to assure all people access to primary care. This failure results in
insufficient support and financial incentives for operating and modernizing primary care
practices, training the future primary care workforce, and attracting physicians and other
clinicians into careers in primary care.
The principal internal threat consists of the failure of primary care clinicians and practice
organizations to more nimbly and imaginatively innovate and implement new practice
models in response to changing population health needs and the growing clinical demands
of primary care practice. A complacency with conventional practice models and practice
roles in primary care, coupled with rigid accreditation regulations governing the training of
primary care physicians, have impeded the ability of primary care practices to adapt to the
changing health care landscape and fulfill the key functions of primary care.
The Center for Excellence in Primary Care was created in 2005 to respond to these
challenges. The mission of the Center is to catalyze the transformation of primary care at the
regional, national, and international level.
The following principles underpin the work of the Center:
All patients have the right to a primary care home which is affordable and promptly
accessible when assistance is needed, and delivers high quality care based on medical
evidence, in a compassionate and culturally competent manner.
A work environment that produces burn out and professional dissatisfaction among
primary care clinicians is inimical to high quality health care for patients.
A greater share of health care resources in the US must be invested in primary care,
including a reduction in the payment gap between primary care and specialty services.
20 th Century models of primary care will not meet the needs of a 21 st Century health
system. Bold innovation and redesign of primary care practice models are imperative.
Advocates for primary care must be willing to engage in reflection and self-criticism,
challenge conventional ways of doing things in primary care, and take risks in
experimenting with new approaches to delivering primary care and educating primary
care clinicians. Best practices in innovation must be disseminated and shared to promote
a learning community in primary care redesign.
Primary care is a “team sport.” Physicians working alone cannot successfully deliver the
primary care basket of services. In addition to the need for teamwork among the diverse
groups of health care workers involved in primary care, patients and consumers must be
recognized and fully engaged as key members of the primary care team. Sectarian strife
among the different specialties and professions that comprise the primary care clinician
workforce is counterproductive.
Experiments in primary care redesign must be accompanied by ongoing evaluation to
provide an evidence base for understanding the effects of these changes on patients,
clinicians, and others.
Based on these principles, and to advance the Center’s mission, the Center for Excellence in
Primary Care has the following specific aims:
To disseminate primary care innovation. The Center will use a multi-pronged strategy to disseminate examples of primary care
innovations and practice redesign to highlight “best practices” and showcase illustrative
models for an audience seeking to innovate in their own practices. Dissemination
vehicles will include a periodic “Primary Care E-Letter,” web site postings, journal
articles, conference convening, and related strategies.
To inform and advocate for policy changes to produce greater investment in primary
care. The Center will perform novel policy research and compile existing research to
contribute to the evidence base to support investment in the primary care infrastructure.
The Center will develop a communications strategy to ensure that this evidence is communicated in a way that is intelligible and compelling not only to health
professionals, but to policymakers, health care purchasers, and the public.
To transform primary care at the regional level and create a model for nationwide reform. The Center will reach out to integrated delivery systems, medical groups, community
health centers, county health departments, health care purchasers, health plans,
government agencies, consumers, and other entities and engage them in a campaign to
boldly reform the delivery of primary care across health systems in the San Francisco
Bay Area. The campaign will encourage delivery systems to implement ambitious new
models of primary care, and purchasers and payers to reform payment and regulatory
policies in support of these innovations.
To evaluate primary care innovations. The Center will conduct research to evaluate innovative models of primary care, changes
in the financing and organization of primary care, interventions to strengthen the
clinician-patient partnership, and other crucial issues, in order to strengthen the evidence
base guiding the transformation of primary care. The Center will strive to conduct
research that is both rigorous and relevant, emphasizing the translation of research
evidence into practice.