RESEARCH ARTICLES

The Politics of Primary Care Expansion

Lessons From Cancer Survivorship and Substance Abuse

Skinner, Daniel PhD; Franz, Berkeley PhD; Howard, Jenna PhD; Kelleher, Kelly MD; Crabtree, Benjamin F. PhD

assistant professor of health policy, Heritage College of Osteopathic Medicine, Ohio University, Dublin, Ohio

assistant professor of community-based health, Heritage College of Osteopathic Medicine, Athens, Ohio

research associate II, Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey

director, Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio

professor, Department of Family Medicine and Community Health, Robert Wood Johnson Medical School

For more information about the concepts in this article, contact Dr. Skinner at [email protected].

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.jhmonline.com).

Journal of Healthcare Management 63(5):p 323-336, September-October 2018. | DOI: 10.1097/JHM-D-16-00030

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Abstract

EXECUTIVE SUMMARY

The purpose of this study is to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. Data were obtained from the 2015 Working Conference for PCMH (Patient-Centered Medical Home) Innovation funded by the Agency for Healthcare Research and Quality. The conference convened representatives from 10 innovative primary care practices and content experts to discuss experiences with integrating care for two nontraditional populations: patients with substance abuse issues and cancer survivors. Transcripts of the conference, one-on-one interviews, and written summaries of practice innovations were coded in NVivo (QSR International) and analyzed by means of an immersion/crystallization approach to identifying thematic patterns. Our study findings suggest that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust. Though support is increasing for primary care expansion and care integration, policy change may precede the identity transformations necessary for medical practitioners to embrace new primary care–centered models. For this reason, it is important that the formation and entrenchment of professional identities be critically considered as part of future efforts to transform primary care practice.