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RE: Primary Care 2.0: A Prospective Evaluation of a Novel Model of Advanced Team Care With Expanded Medical Assistant Support
This article demonstrates the importance of reporting failure. Stanford's Primary Care 2.0 experiment was well conceived and had the potential to make sweeping changes in primary care. The bedrock of the change was a 2:1 MA-to-clinician ratio, with clinician visits becoming team visits including both clinician and MA. The expanded MA included scribing, population health management, and between-visit care management. The model is based on the team-care models of BellinHealth in Wisconsin and the University of Colorado primary care redesign. In both those cases, primary care practices were able to see more patients, thereby improving access, while increasing clinician satisfaction and significantly reducing clinician burnout. The key was the in-room documentation done by the MA which liberated clinicians from the deadly documentation burden.
Why was Stanford unable to sustain this powerful intervention? It seems that health system leadership pulled its support, ending the extra MA workforce, and thereby returning to the status quo ante. There may be other reasons that the article's authors understand but that may not have been appropriate to divulge in an academic publication. Yet the primary care world needs to know when "bright spots" like Bellin and Colorado persevere while Stanford falls back. Few bright spots last forever and many internal and external conditions can cause the brightness to dim. But for those of us who honor the commitment of leaders to create a bright spot, we become wiser both from successes and failures. As a non-Stanford person, I cannot judge what successes remain and what can be resurrected. Congratulations to the Stanford team for their excellent work.