How to cite this paper:

Kabcenell AI, Langley J, Hupke C. Innovations in Planned Care. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2006. (Available on www.IHI.org)

Despite significant efforts to improve the care provided to patients in clinics and office practices, it is still not nearly what it should be. Patients often cannot access or do not receive the care necessary to ensure positive health outcomes. Compounding this, the structure of service delivery, traditional workforce roles, and the reimbursement system all create barriers to making widespread improvements to primary care. A different system is needed, one that is reliable, proactive, efficient, and engages patients in ways that ensure the best outcomes.

The Institute for Healthcare Improvement (IHI), along with partners across the country, is championing a comprehensive effort to improve care in clinics and office practices by encouraging organizations to create a reliable and lean system of planned care for all patients. Building on significant knowledge and experience, IHI is developing and testing a new design for the delivery of primary care for all patients, which reaches high levels of effectiveness, efficiency, and patient-centeredness.

The design is based on the idea that in order to ensure reliable care delivery, every patient should have a plan for his or her care. This calls for changes in four key elements of the service delivery system:

• The care team
• Patient activation
• Clinical information system
• Leadership

Only when all four aspects of the system are changed simultaneously can organizations produce better outcomes without increased costs.

In this paper, IHI identifies the challenges faced in the current system, introduces a new design for the delivery of primary care, and encourages office practices and clinics to move ahead with their own efforts to strive for better patient outcomes.