Dr. Dhruv Khullar: Primary Care Transformation Across The Largest Safety-Net Health System In The United States

A strong primary care foundation is widely understood as important for high-value health care systems. Greater use of primary care has been associated with better patient satisfaction, lower costs, fewer hospitalizations, and lower mortality. Recent delivery system reform efforts, including accountable care organizations (ACOs), have focused on primary care transformation to ensure that care is more accessible, coordinated, continuous, and comprehensive.

While the need for a robust primary care foundation is increasingly evident, putting these principles into practice has proven challenging—particularly in safety-net health systems with limited resources. Clinicians and support staff often have engrained workflows, and implementing new initiatives can feel disruptive, unless clinical benefit is immediately apparent. Lack of core infrastructure—especially staff and technology—to support innovation across the entire system can mean many innovations remain local, short lived, or both. In safety-net health systems, high rates of turnover among frontline staff and program management can lead to institutional knowledge deficits and jeopardize program buy-in and sustainability. Finally, it can be difficult to implement separate (sometimes competing) initiatives simultaneously, even as fundamental and widespread changes are needed.

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