Russell Phillips, MD, Brings His Expertise in Primary Care to Integration Efforts

August 31, 2020
Russell Phillips, MD, headshot

Russell Phillips, MD, is the William Applebaum Professor of Medicine at Harvard Medical School, as well as a professor of Global Health and Social Medicine. Phillips is also the director of Harvard Medical School’s Center for Primary Care. A graduate of MIT and Stanford Medical School (BIDMC), Phillips did his residency in internal medicine at Beth Israel Deaconess Medical Center, followed by a fellowship in General Medicine and Primary Care.

After becoming interested in the quality of patient care, Phillips began work on a national study aimed at improving care for seriously ill patients, and a study funded by the Agency for Healthcare Research and Quality (AHRQ) on the quality of care for Asian Americans. Phillips eventually became the director of the research program in the Division of General Medicine at BIDMC and led the Harvard Fellowship Program in General Medicine, even starting a new fellowship program on the investigation of complementary and integrative therapies. In 2002, Phillips became division chief of the Division of General Medicine at BIDMC. In 2012, he transitioned to the role of director at the Center for Primary Care at Harvard Medical School (HMS), where he met Dr. Bruce Donoff, DMD67, MD73, and first became interested in oral health integration into primary care.

At the Center for Primary Care, Phillips works on a variety of research programs, serves as co-principal investigator on a grant funded by AHRQ, leads programs on financing innovations in primary care, and is involved in different programs centered around education, innovation, and entrepreneurship, and practice transformation. Phillips has published more than 250 manuscripts with nearly 40,000 citations.

How long have you been collaborating with the Initiative to Integrate Oral Health and Medicine and the Center for Integration of Primary Care and Oral Health (CIPCOH)?

I started working on integration shortly after becoming the director of the Center for Primary Care at Harvard Medical School in 2002. I was introduced to it through former HSDM dean, Dr. Bruce Donoff, DMD67, MD73, who was an ardent proponent of both primary care and integration, and I was interested in innovation in primary care. I saw integration of oral health as a way to address equity in oral health, and to improve the value proposition of both primary care and oral health. When the Health Resources and Services Administration (HRSA) created the opportunity to apply as an Academic Unit focusing on oral health integration, I joined with Drs. Christine Reidy and Hugh Silk to apply for funding for what would become the Center for Integration of Primary Care and Oral Health (CIPCOH), which was funded and is now in its fifth year.

You are the director of Harvard Medical School’s Center for Primary Care. Can you talk about how the Center’s goals align with those of the Initiative and CIPCOH?

We focus on education, innovation, and practice redesign, so integration of primary care and oral health is very aligned with the goals of the Center. In fact, in addition to CIPCOH, we have a grant called Advancing Teams in Community Health Program where we work with community health centers in Massachusetts to improve care, and some of the community health centers work on oral health integration. I have also collaborated with investigators at the Harvard School of Dental Medicine (HSDM) to show that after an initial investment, primary care practices can make money if they offer oral health services, in addition to improving the quality of care they provide to their patients.

You recently authored an article in Health Affairs titled, “Primary Care Practice Finances in the United States Amid The COVID-19 Pandemic.” Can you summarize the impact that COVID-19 has had on primary care practices around the country, and whether the pandemic will have a long-term effect on patient care and the cost associated with it?

In some ways, COVID-19 has been devastating for primary care practices. Since they are paid primarily through fee for service, if patients don't come in to the practice, there is no revenue to support the work of the primary care team, and as many as 20 percent of practices may need to close. On the other hand, the pandemic has demonstrated the importance of primary care as the first contact place that patients with COVID-19 symptoms go for care, and has also demonstrated its capacity for rapid changes as practices incorporated telemedicine as a way to connect with patients regardless of their being able to come into the practice for care.

Do you believe the COVID-19 pandemic presents more challenges to integrating oral health and primary care, or more opportunities?

I think COVID-19 presents more opportunities as it has forced both dental practices and primary care practices to become adept at telemedicine, which will be an important way to deliver care in the future. It also creates opportunities for virtual integration through virtual consults and referrals, and we are interested in testing that by doing a project now on integration of oral health and primary care practices.

What projects or research opportunities are you most excited about in regards to the Initiative to Integrate Oral Health and Medicine and CIPCOH?

I think it is important to show the value of both oral health and oral health integration. We have done an analysis showing that in counties in the U.S. with a higher density of primary care doctors, life expectancy of people who live in that county is better. Lisa Simon, DMD14, MD20, is working on a similar analysis of dentists which I am very excited about. I would also like to see a study that evaluates where patients who see both dentists and primary care doctors have lower costs and better outcomes that patients who see only dentists or primary care doctors alone.

You’ve been working on a project titled, “Practice of Future.” Can you share more about what that project hopes to achieve?

The “Practice of the Future” is a fully integrated teaching practice with primary care, oral health, and behavioral health all collocated and integrated. Dr. Bruce Donoff, Jane Barrow, and I all worked on it together with consultation from Qualis Health in Seattle. We continue to be excited by the model and the outstanding care and training it would offer our patients and trainees.

Why do you think the integration of oral health and medicine is important in the changing landscape of healthcare?

I think it is important because of the huge inequities in access to dental services, and to health care generally. In the Center, we are advocates for universal coverage, meaning that all patients should have access to primary care, including oral health. If primary care doctors knew more about oral health and referred their patients to dentists when they detected oral health problems, and dentists screened for primary care concerns such as high blood pressure and referred patients who lacked a primary care physician to primary care, I think patient outcomes would be improved, but we need to show that in a careful study.

Where do you see oral health and medicine in ten years?

I think the data will show value in oral health integration, and our educational models will have changed, leading to more integration of oral health and primary care, with some practices featuring co-location, or dentists and primary care doctors under the same roof, while in smaller practices, there will be a reliable and easy system of cross-referrals based on screening being done for both oral health and primary care issues by both dentists and primary care clinicians.