The problem: The primary care model of practice is broken. Too often patients are dissatisfied with the care they receive, while physicians are frustrated that the current system financially penalizes them for spending more than minimal time with a patient and practicing preventive care.
The proposal: Create a new model of primary care that allows doctors to spend more time with patients, deliver more preventive and wellness care, and adopt innovative features that better meet the needs of patients.
Fernandopulle's story: “It's about the relationship between us and our patients,” says Rushika Fernandopulle, a primary care physician turned social entrepreneur, of his motivation to start an alternative internal medicine practice in 2004. The Harvard-trained physician is not talking about alternative medicine, but of a distinctly different approach to caring for patients at his suburban Boston practice dubbed Renaissance Health.
“Primary care today doesn't feel like the way medicine should be practiced,” observes RWJF Senior Program Officer Stephen Downs, S.M. “There is a small group of entrepreneurs that feels passionately about building a better (approach),” Downs says, “and Fernandopulle embodies that entrepreneurial approach to change.”
“The status quo needs to be upset,” Fernandopulle insists. “Sure it's risky, but it is risky not doing anything.”
In this different approach, patients get more time, not less, with their doctors; get same- or next-day appointments; and receive follow-up calls from their doctors after an office visit. Patients can contact their doctors anytime by phone or e-mail. Doctors can focus on patient wellness and proactively assist patients, rather than reacting to problems.
At the heart of this fledgling “relationship-centered practice” model, is a membership fee. Renaissance Health charges patients $20 to $40 a month for services that are not covered by insurance.
The fee “changes the nature of the relationship,” says Fernandopulle, who, as the first executive director of the Harvard Interfaculty Program for Health Systems Improvement, has helped health care leaders tackle some of the thorniest problems facing the health system. When paying a fee, patients expect more of their physicians and hold them more accountable. The fee also allows each of Renaissance Health's physicians to limit their patient load to 600 to 800, far fewer than the 2,000 to 2,500 patients a primary care doctor typically is responsible for treating. Limiting the number of patients allows doctors to focus more intensively on each patient.
But do not confuse this model with concierge care, the high-touch personalized care that well-heeled patients get in exchange for paying a boutique practice thousands of dollars a year. Fernandopulle's approach is far more affordable and unlike concierge doctors his involves a wholesale redesign of a primary care practice.
Fernandopulle and colleagues visit other innovative practices for ideas to test at their practice. “Renaissance Health is a lab,” he says. “We need a lab to test ideas.”
“Group patient visits” have been adopted where patients with a common condition, such as diabetes, see a doctor together as a group—with patients learning from each other and the doctor. Other ideas being tested are e-mail follow-ups to office visits and the use of electronic medical records.
Under the RWJF grant, Fernandopulle is attempting to take a grassroots movement and organize and advance it as a new model of primary care. He is bringing together other primary care innovators to define this new model, while creating research collaborations to measure how the model impacts costs, outcomes, and patient and physician satisfaction. This fledgling movement has to prove itself through research, Fernandopulle says, in order for it to supplant the current—albeit broken—primary care system.
RWJF promotes fundamental breakthroughs in health and health care through innovative projects, including those from nontraditional sources and fields.
Who: Rushika Fernandopulle, M.D., co-founder, Renaissance Health
What: Conference to help define a new model of primary care based on existing innovative practices.
Where: Renaissance Health, Arlington, Mass.
When: January 2005 to June 2005
Grants received: $71,000
Grant ID#: 51840
Interest Area: Pioneer