PCC's Champion of the Month: David Blumenthal, MD

Thoughts on the trends within primary care with Dr. David Blumenthal: 

David Blumenthal, MD recently stepped down after ten years at the helm of the Commonwealth Fund. Among Dr. Blumenthal’s many accomplishments is the Fund’s investment in international and U.S.-focused research demonstrating the outsize role primary care plays in high-functioning, more equitable health care systems.
 
In 2022, Dr. Blumenthal shared his perspective with the PCC Board of Directors on recent trends in primary care practice organization, investment and ownership models. His remarks echoed themes found in his Harvard Business Review post, “Amazon’s foray into primary care won’t be easy.”  
 
With a wide lens from a career that includes primary care practice, research, teaching, and serving as the first HHS Coordinator for Health Information Technology after the passage of HITECH, before joining the Commonwealth Fund in 2012. Dr. Blumenthal sees a “deep ambivalence” in the U.S. about whether medicine is “a calling or a market.” Is it a profession that should be practiced in partnership with charitable enterprises for the benefit of communities? He noted that nonprofit health care institutions have contributed to the unbalanced flow of funding that goes disproportionately to specialty care while they became more business-oriented and failed to build a strong primary care sector.
 
Contrasting the large, incumbent health systems with entrepreneurs—many of them physician-entrepreneurs—Dr. Blumenthal sees a business opportunity for primary care. Using technology and teams, costs and workflows can be streamlined, and reliability and patient experience improved. One Medical followed this model, he noted. By also taking responsibility and risk for total cost-of-care in advanced payment models, investor-backed primary care organizations can realize more financial upside for investors. This explains the strong interest in insurer-primary care collaborations in Medicare Advantage. As Wall Street has taken notice after venture capital-backed startups have gone public and reached high valuations, more private capital in more forms has poured into primary care, observed Dr. Blumenthal.
 
A Time for Optimism?
How should primary care advocates like the PCC think about this moment? Dr. Blumenthal believes the future of these entities depends in part on whether founders can build strong cultures before they are bought by larger companies, and whether their new owners will have a long-term orientation. A long-term orientation that sustains investments and innovation in primary care in diverse communities is needed to produce better, more equitable health outcomes. Amazon—which is acquiring One Medical-- is known for taking the long view, he noted.
 
Will traditional values of professionalism among physicians and other clinicians be respected and nurtured in these new entities? Quarterly metrics for Wall Street can be destructive if they lead to practices for maximizing income and growth at the expense of quality and community needs. Yet nonprofit health care institutions are also known to practice revenue-maximizing tactics rather than aligning their business models with communities’ interests in generating better health outcomes and investing in community-based primary care.
 
Where does that leave us in this moment of high private investor interest in primary care? Dr. Blumenthal stimulated a robust discussion among the PCC Board. He is optimistic that moves by Medicare and eventually Medicaid to transition away from fee-for-service and contract with primary care in alternative payment models will not be short-lived. When well-designed and managed, these models show promise for supporting primary care that can focus on the prevention and management of chronic conditions and whole person care with resources and incentives to serve all communities. Professionals and advocates must use our voices to shape this era of private investment that is spurred in large part by policy choices made by Medicare and Medicaid.