How Dean Clinic Redesigned Primary Care

Jim Molpus, April 22, 2013

This article appears in the April 2013 issue of HealthLeaders magazine.

Editor's note: This piece is excerpted from a full case study that is available as part of the upcoming May 21 event, HealthLeaders Media Live from Dean Clinic. For more information, visit www.

One of the beauties of running an integrated delivery system that has physicians, a health plan, and affiliated hospitals is the ability to look at influencers of healthcare costs in a systematic way. Craig Samitt, MD, president and CEO of Madison, Wis.–based Dean Clinic, says a few years ago he asked the organization's health plan to pull some data on primary care.

"We asked our health plan what percent of total cost of care goes to pay primary care, essentially to pay primary care physicians," Samitt says. "We were shocked to hear that it was only 6% of the total cost of healthcare. And then we asked our health plan to what degree does the work of primary care—referral patterns, prescribing, everything that they do—influence the remaining 94%. And the health plan said our primary care physicians directly and indirectly drive another 80% of the costs. So if you're going to start some place to catalyze value-based transformation, primary care is the best possible place to start."

In 2009, Dean Clinic was not getting the kind of quality and experience results it wanted from primary care, says Mark Kaufman, MD, chief medical officer for Dean Clinic. At that time Dean's primary care network was not unlike others across the country—somewhat fractured, with difficulty in recruiting physicians and keeping patients happy.

"We said we really needed to make this a major effort," Kaufman says. "I think primary care redesign is one of if not the most critical pieces of clinical redesign that a health system has to undertake if you're going to get to that goal of flipping the paradigm from a sick model of care to more of a wellness and maintenance model of care."

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