Samar Nassar, Healthcare Director, KPMG in Saudi Arabia, on the shift towards proactive team-based primary care in the Kingdom.
Within the global healthcare practice, evidence has been growing that primary care is not merely another medical service or gatekeeper to specialist care, but rather the foundation on which almost all the world’s best health systems are built.
However, many of the world’s healthcare systems were not built upon this evidence. Often, patients are referred to specialists and tertiary care very early on in their treatment and spend more time at hospitals than at community clinics or primary care centers.
The healthcare ‘pyramid’ — that sends patients first to tertiary rather than primary care — needs to be flipped. This transformation can make healthcare more accessible and affordable while improving results for patients.
Video: Dr. Anna van Poucke, Global Head of Healthcare, KPMG International, on healthcare transformation worldwide
The impetus behind the need to strengthen global primary care systems is clear. Non-communicable diseases are on the rise, while the segment of the population most vulnerable to these diseases is growing. According to the UN, the number of people over the age of 65 is projected to double to 1.5 billion in 2050, or about one in six people in the world.
Both of these factors—a rise in NCDs and an aging population—are best addressed through primary care-centered healthcare systems. Such systems are better at identifying diseases early, treating those diseases and encouraging lifelong habits that will reduce the chance of poor health outcomes.
The primary care-centered model is central to Saudi Arabia’s ongoing healthcare reform agenda. Properly stewarded, the transformation program creates an opportunity to deliver primary care in an innovative way that matches the local assets and needs of the Kingdom.
In the recent five-year evaluation of Vision 2030, Crown Prince Mohammed bin Salman specifically identified primary care as the core pillar of the healthcare transformation agenda, stating that every citizen should have a primary care physician.
The Ministry of Health is now rolling out a new model for primary care, team-based care. Led by Assistant Deputy Minister of Health for Primary Health Care, Dr. Khalid Al-Abdulkarim, the concept brings health and wealth services closer to citizens and away the traditional medical field. With more attention paid to prevention and lifestyle, healthcare services are patient-centric and aimed at delivering a better patient experience and improved health outcomes.
Saudi Arabia’s primary care system is already noted for a number of successes, not least the impressive gains in maternal health in the 1990s and early 2000s, and improvements in access to care for rural populations. A recent study also highlighted strengths in the supply chains servicing clinics and the availability and use of clinical guidelines for family medicine.
Still, there is room to improve primary care systems around the world and in Saudi Arabia. Established health systems are struggling to reshape their traditional models of primary care that, though they have served well in the past, are increasingly out of step with 21st century disease trends and the ways that patients wish to seek care. At the same time, many low- and middle-income countries are building up their primary care systems from a ‘blank slate,’ and in doing creating entirely new, low cost and flexible ways of delivering services at scale.
Innovation abounds in the way that primary care is being conceived and delivered, making this an ideal time for Saudi Arabia to be planning its future services and models—taking lessons from around the globe and blending them with the unique assets that its communities have to offer and what citizens say they most want.
The main challenges and opportunities of Saudi Arabia’s ongoing healthcare transformation are examined in KPMG’s "The paradox of primary care: How Saudi Arabia can leapfrog world-class primary care systems.” Based on a global case study on healthcare systems around the world, the report proposes four design principles to improve primary care in the Kingdom:
In the face of rising complex morbidity and shifting patient expectations, new models of primary care are seeking to enhance how access and continuity are provided.
One of the ways of achieving this is to bring the primary care clinic itself closer to or even inside the hospital campus, as is the case in King Faisal Specialist Hospital & Research Center and King Abdulaziz Medical City.
In addition, it can be achieved by networking clinics together such that they can make shared investments in new services, as well as creating professional HR, IT, leadership and management teams.
The government of Saudi Arabia has been making determined efforts to graduate more family physicians to build up the required workforce for a fully comprehensive, primary care-oriented health system.
While the family physician remains the bedrock of most high-income primary care services, many world-class systems have changed their understanding of primary care workforce development in recent years towards more ‘team-based’ model.
The shift towards proactive team-based primary care is one of the key features of a related shift towards population health management and an enhanced role for patients themselves.
The development of accountable care arrangements is one of the most transformational components of the Kingdom’s ongoing reforms and one of the most promising enablers to drive the scale-up of primary care. Many countries are currently seeking to develop the ‘primary care medical home’, where a family medicine practice assumes full responsibility for the health and care of its enrolled patients. It is a bold concept that relies on a number of other changes taking place at once.
As value-based payment mechanisms are introduced, it is critical that a more primary-care oriented cadre of managers and leaders are developed to support service change.
This is a challenge shared by many health systems around the world as they seek to scale up and professionalize the organization of primary care. Professionalized management of integrated care can be developed within the existing workforce.
Transparency over the performance of providers and payers is another key ingredient in reducing variation and challenging local health systems to improve.
Applying these design principles involves a constant tension between moving change forward at speed and scale while not stifling local ownership and innovation that is essential to truly changing beliefs and behaviors at the front line. The stakes are high, but an improvement of long-term health outcomes is something all stakeholders can easily get behind.
Find out more: The paradox of primary care and other publications by KPMG on the healthcare industry in Saudi Arabia