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Achieving better value: primary care must lead on population health
  1. Theodore Long1,2,
  2. Ali M Khan2,3,
  3. Nav Chana4
  1. 1Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA
  2. 2Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  3. 3Iora Health, Boston, Massachusetts, USA
  4. 4National Association of Primary Care, London, UK
  1. Correspondence to Dr Theodore Long, Robert Wood Johnson Clinical Scholars Program, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT 06520, USA; theodore.long{at}yale.edu

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Whether in the USA or UK, the resounding question in the health sphere is: How do we achieve better value in healthcare? The answer to date has been simple: get bigger, merge administrative departments, get more managerialised, and so cut costs. But none of this represents real change: just some tinkering of the current hospital-centric system. In order to find a sustainable and effective solution, we must consider value and not cost while focusing on what contributes to better health. This means becoming serious about caring for people beyond a hospital's walls. Population health, which links health outcomes for a population to the context of medical system and social determinants of health,1 offers the promise of dramatic improvement in value and personalisation for patients. This is not to diminish or downgrade the importance of continuing to improve healthcare for the individual, but rather to link that with an active approach to improving health. Doctors and other healthcare professionals will need to refocus their roles and renegotiate their relationships across the healthcare sector.

Health systems across the globe are pressured to derive greater value in healthcare, which in the context of the continuing groundbreaking developments in medical technology must now centre on becoming serious about population health. The Institute for Healthcare Improvement's triple aim sets out the laudable ambition for all health systems: improving the health of populations, enhancing the patient experience of care, and reducing the per capita cost of healthcare to ensure benefits can be applied across communities. It is the first of these, improving the health of the population, that is the most difficult and which seems out of the scope of healthcare. Delivering on this promise will not happen without clear leadership.

Primary care—which assumes nearly 60% of all US patient visits and 90% of …

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