EP445: Can a Primary-Care-Only Practice Survive in 2024? With Tom X. Lee, MD

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Jul 25, 2024

Tom X. Lee, MD discusses the paradox of sustaining primary care practices independently. The podcast highlights the challenges faced by primary care entities in balancing revenue and high-cost services. Topics include the importance of enlightened leadership, value-based care, balancing financial incentives with societal impact, and recruiting dedicated doctors for long-term success.

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INSIGHT

Hidden Waste in Primary Care

Much hidden waste in primary care lies in underutilized clinician and staff cognitive capacity and excessive busy work.
Optimizing workflows and reducing chaos can better engage workers and improve productivity in primary care.

ADVICE

Define Value Clearly

Define value by clear goals including financial, patient-reported, clinician-reported outcomes, and performance metrics.
Avoid efficiency drives without understanding quality to prevent cutting corners and diminishing value.

INSIGHT

Access vs Longitudinal Care

Access is a necessary first step for quality primary care, but access alone is insufficient without longitudinal relationships.
Retail clinics typically fail as primary care destinations because they lack longitudinal care and are mainly transactional.

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I wanted to talk with Dr. Lee because so many RHV (Relentless Health Value) listeners are trying to figure out how to sustain primary care as a stand-alone entity when the most obvious and most common way to make enough money in primary care is to drive and maximize the dollars from downstream volume of high-priced service lines, which, if you think about it, undermines the entire point of primary care.

In Episode 445 of Relentless Health Value, Stacey Richter interviews Dr. Tom Lee, founder of One Medical and Galileo, about the sustainability of standalone primary care practices in 2024. Dr. Lee also was a founder at Epocrates

They discuss the paradox of primary care, the economic challenges of running an independent practice, and the importance of enlightened leadership with a value-focused mindset.

Dr. Lee emphasizes innovative service operations, cutting hidden waste, and balancing human-centered care with efficient processes. The conversation explores various facets of primary care, including access, longitudinal patient care, and the role of technology.

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07:02 What is the paradox of primary care?

09:19 Why is it hard to run an independent primary care practice?

10:01 What are the barriers to running an independent primary care practice?

10:41 Can you have fee for service and value?

12:25 "Value is more about a mindset."

13:22 What hidden waste is there in a primary care practice?

15:11 What do you need to have a value-focused mindset?

17:14 Why does access precede quality?

18:20 Why have retail clinics failed in being longitudinal primary care destinations?

20:29 What is a longitudinal primary care destination and why does it matter?

23:48 What are the nuances of a service business that make them challenging for managers?

24:35 How do you find the balance between fee for service and value?

31:17 EP438 with John Lee, MD.

32:14 How can you invest in quality without a value-based contract?

34:19 How do you address the trade-off between fee-for-service finances and investing in value-based care?

35:36 Where is the "productive middle"?

36:27 Dr. Tom Lee's message to payers.

39:55 Dr. Tom Lee's message for policymakers.