In Their Words: Consumers' Vision for a Person-Centered Primary Care System

Executive Summary

The Center for Consumer Engagement in Health Innovation commissioned these focus groups to understand consumer experience with and attitudes about primary care, and the intersection between the primary care relationship and social determinants of health. This work focuses on marginalized consumers of health care, including people who are low-income, who have disabilities, who come from communities of color, whose primary language is not English, who are elderly, and/or who have complex health needs. These focus groups, conducted in August and September 2019 among nine distinct consumer segments spread across four states, identified a population that generally does not feel well-served by the health care system they encounter today. These consumers are dealing with a variety of significant challenges that in their estimation are having a direct impact on their health, while also impacting their ability to access needed health care and social services. These challenges are often defined by severe financial stress, and include lack of reliable transportation, food insecurity and lack of access to healthy food, and housing insecurity. People also described substance use and difficult mental health and emotional challenges, including loneliness among elderly participants and stories of family separation and estrangement.
The consumers we interviewed see a health care system that is financially driven, leading to short and impersonal primary care visits. They are cynical about a system that they feel is designed to churn them through as quickly as possible and move on to the next patient. Most focus group participants could identify a primary care provider, but very few felt they had a provider who knew and understood them. Fewer still had a provider who engaged them in a broader discussion about external factors that helped determine how healthy they were, though nearly all of these consumers would
welcome that broader discussion. Asked to imagine a health care system that would do a better job of helping them live their healthiest, best
lives, these consumers rose to the occasion, offering a variety of suggestions that we have synthesized into five thematic aspirations:

1. Consumers want a long-term relationship with their primary care provider, someone who will listen patiently and get to know them.

2. Given the complexity of the health care and social service systems, as well as the complexity of their own need, consumers value the idea of a coordinator or navigator who can help them manage their care and is willing to advocate for them when needed.

3. Consumers welcome a broader conversation with their primary care provider, not just focused on their medical treatment, but exploring the needs of the whole person.

4. Consumers resonated with the concept of a “one-stop shop” where they could receive a wide variety of services under one roof, including medical services, mental health treatment and counseling, and social services.

5. They hope for a provider who is culturally sensitive, able to relate to the consumer’s own life experience and struggle, and who uses language consumers can understand.

This research answers many questions about consumer needs, anxieties and expectations. Fruitfully, this work also raises many questions that policymakers and experts must consider in developing a more accessible system that consumers desire.