California Advanced Primary Care Institute (CAPCI) to Launch January, 2013

Statewide Non-Profit Organization Aims to Urgently Revitalize Primary Care

LOS ANGELES--()--Beginning January, 2013, the California Advanced Primary Care Institute (CAPCI) will launch itself as a broadly inclusive organization and multi-pronged effort to improve the appeal of primary care as a career choice and simultaneously elevate the performance of primary care teams.

“Sadly, California faces a serious erosion of primary care workforce at the same time that our state braces for a daunting bulge in chronic illnesses and the long awaited opportunity through health reform to serve millions of previously uninsured individuals and families.”

CAPCI emerged from a statewide consensus meeting in April, 2012, sponsored by the California Association of Physician Groups. CAPCI, a non-profit foundation, convenes its first plenary Steering Council meeting in January, 2013.

“Primary Care is the cornerstone for all of California’s health care delivery systems and sets the foundation for every goal of healthcare reform,” said Wells Shoemaker, MD, Medical Director of CAPG. “Sadly, California faces a serious erosion of primary care workforce at the same time that our state braces for a daunting bulge in chronic illnesses and the long awaited opportunity through health reform to serve millions of previously uninsured individuals and families.”

California’s primary care workforce will shrink by 30% in the next 5-8 years as a consequence of two converging misfortunes. “Baby Boomer” primary care physicians, for years the load-bearing stalwarts among the internists, family physicians, and pediatricians, are retiring. Newly trained clinicians have been progressively choosing other medical disciplines, cutting the “reinforcements” down to half what they were 15 years ago.

“Given the time it takes to train doctors, advanced practice nurses, and physician’s assistants, this impending shortfall cannot be entirely avoided. We have to use scarce resources in smarter ways, many of them embedded in the concept of the Medical Home,” stated Dr. Shoemaker.

“If we are going to transform primary care to provide superb, patient-centered care to every Californian, we will need to fundamentally change our approach to training the people who work in primary care,” stated Kevin Grumbach, MD, Professor and Chair, UCSF Department of Family and Community Medicine, and member of the CAPCI executive management committee. “This new coalition represents an unprecedented partnership between practice organizations and training institutions to equip the workforce for the innovative care models that will drive excellence in primary care throughout California.”

While previous efforts in California have fallen short in changing primary care workforce dynamics, CAPCI offers hope for a different outcome by addressing two core principles for success:

1. Inclusivity - CAPCI has engaged all four healthcare delivery systems: private sector organizations, community clinics, military and veterans affairs systems, and independent doctors. CAPCI will also feature powerful voices of academic teaching centers, primary care academies (family practice, internal medicine, and pediatrics), advanced practice nurse clinicians and physician’s assistants, as well as health plans, private and public, public health, employers, state and federal government, quality improvement organizations, and healthcare foundations to reach a critical mass. CAPCI is committed to hearing and heeding the “patient voice” early in every strategy.

2. Ambitious Scope of Engagement - Previous efforts have looked at only one or two facets of the challenge, for example, payment disparities or paperwork burden. CAPCI believes that simultaneous efforts need to be made in four distinct areas in order to turn this around. We call those the “Four P’s” -

  • Pipeline. Change the training environment and the appeal of primary care as a career choice for physicians and other clinical professionals.
  • Practice redesign. Practice with greater efficiency, better information, modern communication, and central attention to the patient experience. This is the promise of the Medical Home, but it needs to expand beyond individual offices to community wide scale. Redesigned practices must also embrace California’s unique cultural diversity.
  • Payment. Success requires that payments are aligned with modernized practices to deliver the core of healthcare reform: better health, better care, and better affordability. CAPCI aims to reach a “tipping point” of purchaser strategies that will influence behavior change at the practice level.
  • Policy. Current systems rest on a 60-year hodgepodge of assumptions, regulations, and “conventional wisdom”. That chaos has landed the U.S. (and California) lower than 20th in the world in nearly every public health measure. CAPCI will enable intelligent policy informed by a consensus of knowledgeable contributors that is able to keep pace with changing dynamics.

“Never has such a broad platform been established, and none too soon. With the crunch bearing down, every one of the parties involved in CAPCI ‘has a dog in this race’. Restoring California’s primary care workforce is like repairing a disabled car. You can install a rebuilt engine, but without four good tires, reliable brakes, and bright headlights, you won’t get off the blocks,” stated Wells Shoemaker, MD, Medical Director of CAPG.

CAPCI has received start up funding from the California HealthCare Foundation, The California Endowment, CAPG group contributions, and the California Academy of Family Practice. Membership in CAPCI’s Governance bodies and additional commentary available on


Elissa Maas, MPH, Executive Director, 916-443-4153