Balasubramanian awarded NSF CAREER grant to study delivery of primary care

Hari Balasubramanian of the Mechanical and Industrial Engineering department has been awarded a $400,000 grant from the National Science Foundation’s Faculty Early Career Development (CAREER) Program to research streamlining the delivery of primary care to patients.
Through his project, “Stochastic Models for Designing the Patient Centered Medical Home in Primary Care,” 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, see their own personal care teams and have their primary care physicians manage all aspects of their care.
“As the first point of contact, primary care is the backbone of any health system,” Balasubramanian says. “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 notes that in 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), which 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 family, pharmacies, hospitals and home care agencies. This requires adequately budgeting capacity among care teams consisting of physicians, nurses and other staff, such as 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 this proposal.
“Hari’s research is taking us to a new level in the development and application of industrial engineering and operations researchmethodologies to the solution of a critical national problem, in this case healthcare costs,” said Don Fisher, head of the mechanical and industrial engineering department at UMass Amherst.
At present, there are no clear guidelines available for these practice design questions and their financial viability. Balasubramanian believes that empirically based industrial engineering and mathematical approaches have the potential of providing the necessary rigor. Balasubramanian will work with Mayo Clinic, Massachusetts General Hospital and a small three-provider family medicine practice to collect empirical data for this project.
Balasubramanian welcomes primary care practices in Pioneer Valley currently considering the medical home model to contact him at if they are interested in practice redesign issues.