Stanford Medicine Newsletter Updates For the Local Community


A premium on primary care

Focus on prevention and coordination

Sang-ick Chang, MD, MPH, is spearheading primary care services at Stanford.


In a sign of how the medical landscape is changing in response to health-care reform, Stanford Hospital & Clinics is significantly expanding its primary care services with plans to add 50 new physicians and other providers over the next three years and open several new clinics on the Peninsula.

The effort will be directed by Sang-ick Chang, MD, MPH, a long-time primary-care physician who previously served as chief medical officer for two of the Bay Area’s largest public medical centers. Chang became assistant dean for clinical affairs at Stanford University School of Medicine in August.

The move reflects a trend in health care toward enhancing primary-care services and improving how various providers—family doctors, specialists, physical therapists, social workers and home caregivers, among others—work in concert to treat, educate and prevent patients from becoming ill. This team-based approach is known as comprehensive care, and its growing popularity is related, in part, to President Obama’s landmark Affordable Care Act. Signed into law in 2010, it has encouraged a shift from more traditional fee-for-service treatment models to systems that reimburse providers for the general health of their patients, not just for procedures and individual services.

Finding a balance

Underlying this shift is a huge challenge: How does the nation improve its health care while stopping the explosive rise in health-care spending?

“As a society, we need to find ways to rein in rising medical costs and improve the quality of care,” said Amir Dan Rubin, president and CEO of Stanford Hospital & Clinics. “Dr. Chang has helped to advance these goals by designing and directing patient-centered, evidence-based primary-care systems that emphasize prevention and coordinated care.”

Coordinated care, a central tenet of the health-care reform effort, means that patient information and preferences are shared seamlessly among providers, as well as with patients and their families, during moves from one health-care setting to another—for example, from the cardiology clinic to the radiology lab.

“We’ve learned that you can slash morbidity and mortality rates and their attendant suffering and health costs by adhering to evidence-based treatment guidelines for all patients,” Chang said.

 Evidence-based care is the practice of using the best available information from up-to-date scientific research to determine a patient’s diagnosis and treatment. “This sounds simple,” he added, “but in reality it takes a highly coordinated system that involves information systems, performance monitoring, education and communication, and a team approach to caring for patients.”

Redesigning primary care

Chang has devoted much of his 22-year career to redesigning primary care and health systems to better serve both patients and society. He previously served as chief medical officer of the Alameda County Medical Center, a safety-net health system, and was CEO of the county-owned San Mateo Medical Center, where he oversaw 1,400 employees.

“What attracted me to this position at Stanford was the vision of the leaders both at the hospital and medical school, and the chance to work with a world-class institution to help solve some of the most pressing problems of health care today: bending the cost curve and improving quality and the patient experience by creating evidence-based and patient-centered primary care,” he said.

To this end, the hospital and medical school are collaborating to boost the number of staff, clinics and research efforts in family medicine, internal medicine, geriatrics, palliative care and occupational health, among other primary-care services, said Mark Cullen, MD, chief of the Division of General Medical Disciplines. The aim is to make Stanford a research leader in new approaches to primary care and a recognized destination for comprehensive care—a place where people routinely go for a physical exam in addition to the specialty care for which the hospital is known.

Several clinics are planned for the Peninsula to develop a broader geographical base of Stanford general practitioners. The first will open in Ladera, a community adjacent to Portola Valley, for internal and family medicine.

In addition to Chang, the medical center has hired several senior faculty members who are at the forefront of rethinking how U.S. health care should be delivered: Arnold Milstein, MD, MPH; Alan Glaseroff, MD; Ann Lindsay, MD; and Steve Asch, MD, MPH.

Milstein, professor of medicine, directs Stanford’s Clinical Excellence Research Center—a joint initiative of Stanford Hospital and the medical school—which is dedicated to designing, testing and spreading more affordable alternatives to existing health-care systems. Glaseroff and Lindsay oversee the Stanford Coordinated Care Clinic, which gives intensive primary-care support to university and medical center employees. Asch, deputy chief of the Division of General Medical Disciplines, directs the Center for Health Care Evaluation at the Stanford-affiliated Veterans Affairs Palo Alto Health Care System.


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