Understanding the 4 Cs of primary care
There are four established pillars or tenets of primary care that are associated with better quality services, lower costs, reduced healthcare inequity, and improved population health. It is important as a new independent practice owner to understand these 4 Cs of primary care.
The 4 Cs of primary care are defined as:
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First Contact – access and use of health services whenever necessary
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Comprehensiveness – promotion, prevention, treatment, and rehabilitation appropriate to the primary care context
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Coordination – the integration of all the care the user receives and needs with other health services
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Continuity – a professional-subject-of-care temporal relationship, leading to the establishment of strong mutual trust.
Essentially, these 4 Cs result in the primary care practice team being available for contact when a patient is experiencing an issue, providing comprehensive care continuously, and coordinating the care for that patient when multiple providers are involved. These elements contribute to a trusting and productive provider-patient relationship that can help all stakeholders work toward the goals of effective primary care.
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Though most primary care providers are aware of the 4 Cs, they do not always fulfill them successfully, especially when the practice is based on fee-for-service (FFS) care delivery. Large patient panels and incentives for the number of patients and the number of patient visits can run counter to the idea of providing quality, value-based care.
In addition, while some providers see each “C” as functioning independently, researchers see them as intertwined and dependent on each other, often overlapping. Providing quality care that is comprehensive and coordinated can lead to improved outcomes for the patient and improve opportunities for success for the independent practice.
Achieving the 4 Cs in a value-based care setting may mean that the patient does not always see the primary care provider at each visit but may see other members of the clinical team to ensure that care is provided in a timely and quality manner. Researchers note that the mode of that first contact may also change, with innovations in technology including updated electronic health records (EHRs). Digital health technology and expanded primary care roles can improve that first contact by giving the patient easier and more convenient access to the practice team.
Primary care practices involve a team that typically includes nurses, care coordinators, and other support staff. Care coordination may also involve specialty providers, social workers, behavioral health specialists, lab techs, and pharmacists.
Comprehensive care also involves efforts to spend more time with each patient, to gain a true understanding of the individual’s health status and other life factors. A holistic approach guides treatment options and decisions for all stakeholders involved in the patient’s care.
Incorporating the 4 Cs into your independent primary care practice with a value-based, team approach can deliver improved outcomes. Research has found, in fact, that primary care practices adopting this approach have been able to reduce emergency department visits by more than 13% and reduce hospitalizations by almost 6%.
Contact, comprehensive, coordination, and continuity create a better overall experience and improved quality of care for the patient. The independent physician and the new primary care practice also benefit when patients are more confident in their provider, who has shown genuine care and concern in their overall health and well-being.
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