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Balasubramanian’s CAREER Award Aims to Improve Primary Care Delivery

Hari Balasubramanian of the Mechanical and Industrial Engineering (MIE) Department at the University of Massachusetts Amherst has been issued a $400,000 grant from the prestigious National Science Foundation (NSF) Faculty Early Career Development (CAREER) Program. The award represents the 34th NSF CAREER grant issued to faculty members from the UMass College of Engineering, and the fourth during the 2012-2013 academic year. The title of Balasubramanian’s industrial engineering NSF project is “Stochastic Models for Designing the Patient Centered Medical Home in Primary Care.” In essence, the project will streamline the delivery of primary care to patients.

As MIE Department Head Don Fisher said, “Hari’s research is taking us to a new level in the development and application of Industrial Engineering and Operations Research methodologies to the solution of a critical national problem, in this case healthcare costs.”

“My long-term research goal,” Balasubramanian said, “is to establish the quantitative and optimization frameworks that underpin the operational aspects of healthcare delivery.”

Balasubramanian intends to create new mathematical models that quantify the dynamics of patient demand and care provider availability and supply in a practice so as to ensure that patients receive primary care ASAP (“timely access”), see their own personal care teams (“patient-clinician continuity”), and have their primary care physicians manage all aspects of their care (“care coordination”).  

“As the first point of contact, primary care is the backbone of any health system,” Balasubramanian explained. “Evidence shows that when health systems emphasize primary care, patients realize improved outcomes at lower cost…Streamlined primary care access has been shown to lead to improved population health outcomes, reduced emergency department visits and hospitalizations, and significantly reduced system-wide costs.”

He also noted that a 2006 report by the American College of Physicians stated that primary care faces a crisis due to a “dysfunctional financing and delivery system." And yet primary care is being strained by mushrooming demand: by 2015, an estimated-150 million Americans will have at least one chronic condition.

As a response to this crisis, all the major medical societies in primary care have called for a new model of care delivery called the patient-centered medical home (PCMH). The PCMH model involves practice redesign that improves the delivery of the three core primary care metrics of timely access, patient-clinician continuity, and care coordination in primary care delivery.

In other words, timely access to office visits with one’s own doctor is important, but the care provided cannot be comprehensive unless a primary care physician remains cognizant of and manages the patient's care among multiple entities beyond the primary care practice; that is, specialists, ancillary services, the patient's own family, pharmacies, hospitals, and home care agencies. This requires adequately budgeting capacity among care teams consisting of physicians, nurses, and other staff (possibly case managers and social workers).

A sufficient amount of provider time needs to be allotted for care coordination through phone calls, emails, and monitoring activity in patient portals. Capturing this care coordination burden, how it varies by patient ailment or chronic condition, and how it might impact care team design and ultimately patient outcomes are key tasks of the research that Dr. Balasubramanian has proposed to undertake.

At present, there are no clear guidelines available for these practice design questions and their financial viability. Dr. Balasubramanian believes that empirically based industrial engineering and mathematical approaches have the potential of providing the necessary rigor. Dr. Balasubramanian will work with Mayo Clinic, Massachusetts General Hospital, and a small three-provider family medicine practice to collect empirical data for this project.

He welcomes primary care practices in the Pioneer Valley currently considering the medical home model to contact him at hbalasubramanian@ecs.umass.edu if they are interested in practice redesign issues. (May 2013)