Primary care plays starring role in community health

Success requires everyone to have a provider for essential health care needs

Recognizing that high-quality primary care is the foundation of keeping communities healthy affordably, the UVM Health Network developed a long-term strategy for primary care in 2017.

“We want to ensure that we have enough primary care ‘bench strength’ over the next decade to serve the 500,000 patients in our region,” said Tom Peterson, MD, health care service leader of Family Medicine at UVM Medical Center. Peterson leads the UVM Health Network Primary Care Strategy Council with Lisa Goodrich, VP of Medical Group Operations at UVM Medical Center.

Many patients are well-served by community practices already. As a network, we need to help fill gaps where they exist.

Tom Peterson, MD, Chair, UVM Health Network Primary Care Strategy Council

“Many patients are well-served by community practices already,” Peterson said. “As a network, we need to help fill gaps where they exist so that all patients in our region have access to a patient-centered medical home.”

Guiding principles developed by the Council outline a comprehensive plan that:

  • Builds on the strengths of current Network primary care services to create true, interconnected medical homes
  • Ensures high-quality, standard care-delivery processes that can be tailored to each patient’s needs
  • Fully integrates Network primary care with the broader “medical neighborhood” – specialists, hospitals, pharmacies, the Visiting Nurse Association, senior centers, the community health team and other community partners
  • Creates a sustainable environment in which providers and staff have clearly valued roles and patients know who the members of their care team are and the value they add
  • Uses data to help understand what care improvements are needed and support a broader focus on population health; this includes a goal of bringing all Network primary care sites onto the Epic electronic health record platform
  • Design existing facilities to offer patients one-stop care for routine services and on-site access to mental health care

According to Peterson, this work is designed to create medical homes where preventive, urgent and chronic care, as well as broader community needs, can be met.

There is much work ahead:

  • The challenging job of recruiting primary care providers in Northern New York and rural Vermont
  • Establishing more high-functioning medical homes to increase access to affordable quality health care, especially in Northern New York
  • Increasing access to mental health and addiction treatment services
  • Creating primary care access seven days a week across the Network

Peterson is confident we can get there. “Health care is all about relationships. That’s where we are most successful in primary care – we are committed to long-term relationships with patients, families and the whole ‘medical neighborhood’ team.”

“This is a journey that will not really have an end, as we continue to increase access and react to the changing health care environment,” Peterson said. “Quality goes up and costs go down if you contribute primary care to a region. Our leadership recognizes that, and it is just what we are doing.”

Medical Home?

This is what we mean when we say "medical home."

Our primary care offices are nationally certified as patient-centered medical homes.

Medical homes emphasize team-based care to prevent illness, promote overall health and coordinate specialty care for patients when needed. Once the specialist and the patient’s primary care provider have created a care plan for each patient, patients either return to their medical home for monitoring and support, or continue with specialty care as long as necessary.

The term ‘medical neighborhood’ refers to the broader of health care providers in the community.