Providing Value
Primary care teams provide value for money by speeding up access to care and offering a wider range of programs and services to promote health and manage chronic disease. They bring together the variety of skills needed to help people stay healthy and out of hospital.
Evidence from British Columbia suggests that a very sick patient without access to high quality primary care can cost the province’s system $30,000 a year. The same patient, when aligned with a care model providing comprehensive primary care, can cost just $12,000. In a presentation by Dr. Rick Glazier at the Family Medicine Forum in November 2022, it was suggested that it would cost $100-$200 per person a year to provide the ENTIRE country with a team. Given that ONE ER visit cost $304 in 2018/19 (and has increased since then), providing care in the community of which they live is not just better for the patient but also for the health system. And absolutely more cost effective.
You can also read this comprehensive paper by Dr. Monica Aggarwal on Interprofessional Primary Care Teams: A literature review of potential international best practices for other examples of primary care teams across the country. Other recent articles can be found here.
Making Progress. More is needed
Ontario started building a more coordinated and comprehensive primary care system to meet the needs of patients with family health teams and nurse practitioner-led clinics in the 2000s, but this work has largely stalled. A very small number of new teams have been built in the last decade, expansion funding is limited and sporadic, and teams have not seen an increase in base funding in over 10 years.
The People’s Health Care Act, which received royal assent in 2019, showed the government’s mission to create a new model for patient-centric integrated public healthcare delivery. Interprofessional primary care teams deliver patient-centred integrated public healthcare.
They are the foundation of the healthcare system and will be critical in the success of Ontario Health Teams. They combine the expertise of a range of health professionals and provide comprehensive primary care. This is the care that helps prevent or manage chronic conditions, keep people healthy – both physically and mentally – in their communities, and help prevent hospitalizations. It is the foundation of any successful healthcare system.
Teams are critical in ensuring a stable healthcare system that can provide care in a timely manner for anyone who needs it. With shared locations and electronic medical records, it allows providers to care for their patients with better information and collaboration.
AFHTO Led Initiatives:
This is a link to AFHTO’s Media Statements page where you can find a list of various local advocacy initiatives and our yearly pre-budget submissions.
A Few Team Initiatives:
- South Georgian Bay Healthy Aging Program: Georgian Bay FHT
- Diabetes- It Takes a Village: Aurora-Newmarket FHT
- Coordinating and streamlining access to palliative care resources in the Couchiching sub-region: Couchiching FHT
- Chatham-Kent OHT Partners Collaborate to Host “Pap-a-Palooza” Campaign with Clinics for Unattached Patients: Chatham-Kent OHT
Only about 25-30% of Ontarians have access team-based primary care. We must expand access to teams to anyone who needs it. Both Ontarians and government will benefit from this investment. It improves care and reduces cost to the healthcare system by managing and preventing illnesses and helping keep people out of the more costly hospitals.
Hospitals are for urgent, acute care. They re not for prevention of disease, maintenance of wellbeing, or management of many chronic conditions. That is primary care. It must be better invested in.
Research shows the value of primary care teams. It has presented a set of principles for optimizing the value of teams and offered an initial set of recommendations. Below are some research samples:
- Ontario data support Starfield’s theory on primary care quality and cost. Evidence shows that quality can be measured according to what matters to patients, and higher quality in primary care is associated with lower costs to the health care system.
- Measuring Quality in Primary Care: How do we know what we’re doing is working? (With R. Kirkconnell, A. Macpherson, and R. Annis). This presentation describes the outcomes of 7 iterations of D2D. D2D has been successful in terms of participation, increased EMR maturity, and demonstration of Starfield's observation about the relationship between high quality primary care and lower system costs, but we overall performance on quality and cost measures remains the same.
- Impact of Team-Based Care on Emergency Department Use (With T. Kiran, R. Moineddin, A. Kopp and R. Glazier) This study aims to assess the impact of team-based care on emergency department (ED) use in the context of physicians transitioning from fee-for-service (FFS) to capitation payment in Ontario, Canada
Evidence of Added Value:
Teams improve timely access to primary care
Patients in primary care teams report higher levels of access to care. Key drivers for enhancing patient access include after-hours clinical services, reduced wait times, and interprofessional services. Patients can see the right provider for the care they need and all providers involved in the patient’s care are in the loop. This is integrated, comprehensive care.
Below are a few articles showcasing the value and impact of team-based care:
- Ontario Science Table Recognizes Essential Contributions of Team-Based Care to COVID-19 Response and Recovery, Calls for Stable Funding
- On October 3, the Ontario Science Table (OST) released its final report, a three-part brief about the importance of Primary Health Care (PHC) in the pandemic and what we can learn from it.
- Interprofessional Collaboration in Ontario’s Family Health Teams: A Review of the Literature (2014)
- External evaluation report on family health teams (2014) shows that almost 80% of patients enrolled in a FHT reported that they are able to get an appointment with their family doctor or primary care provider on the same day they need one.
Patients experience better care coordination in primary care teams
Effective care coordination leads to more seamless transitions for patients and families, reduces duplication, increases quality of care, facilitates access, and contributes to better value by reducing costs. Primary care is an anchor for patients and families trying to navigate through the healthcare system.
The primary care team model improves care coordination by increasing communication between healthcare providers through the use of a common electronic medical record (EMR). EMR and systems integration is currently lacking across in other models of primary care in Ontario. Seamless information sharing improves communication among providers, results in less conflicting advice from care providers, and facilitates the transfer of data between providers.
Team-based primary care supports improved management of chronic disease
About one in three Ontarians live with a chronic condition. For those over age 65, close to 80% have a chronic condition; of these, 70% live with two or more conditions. The bulk of chronic disease management is provided through primary care but most physicians simply do not have enough time to address all chronic disease needs in a standard visit.
The team model gives ready access to interprofessional health providers that deliver diverse professional expertise and access to the resources and skills required to manage the “whole patient”. The team model also leverages knowledge of and connections to external services and supports in the community.
This page was created on 09-26-2018, updated on 05-01-2023