For a century, primary care operated around the idea that the patient comes to the clinic during office hours to see their physician. The physician owns the relationship and develops deep ties to triage the patient wherever else they need to go.
That arrangement is being redesigned from the ground up.
Executives at systems ranging from a large multistate networks to federally qualified health centers are abandoning the assumption that primary care is defined by a physical location, a fixed schedule or a single clinician and replacing it with a team-based access system that is longitudinal and deliberately indifferent to whether the encounter happens in a clinic, through a portal or at home.
“Primary care doesn’t exist only inside the brick-and-mortar clinic. A second, largely invisible clinic has emerged alongside it, what I call the digital clinic,” said Surendra Khera, MD, president of Cleveland Clinic Florida’s accountable care organization and vice chief of the system’s primary care institute for the Florida market. He describes the change as a separation of two concepts the old model conflated: continuity and exclusivity.
“We still believe deeply in the longitudinal patient-PCP relationship,” Dr. Khera said. “The PCP remains the anchor. But we no longer believe preserving that relationship means every episode of care must wait for or be delivered by that individual physician.”
The implications are structural. Behind the physical clinic, a second care environment has materialized, driven by a surge in digital communication that the traditional appointment model was never built to absorb.
“Nationally, patient portal messaging increased 153% between 2020 and 2025,” Dr. Khera said. “Symptoms, results, refills, advice and care coordination increasingly arrive digitally, and that work can no longer simply be absorbed around a full day of scheduled visits.”
Cleveland Clinic’s Florida market is now building a parallel team of medical assistants, nurses, pharmacists, advanced practice providers and physicians specifically to manage that digital workload alongside, not within, the physical clinic.
Craig Cheifetz, MD, president of Inova Health System’s primary care service line in Fairfax, Va., describes the shift from an operational design standpoint. His organization has moved away from the assumption that patients will come to the system at a traditional clinic, during traditional hours, through traditional scheduling pathways.
“Rather than asking patients to navigate a complex healthcare system, we are redesigning the system around the patient experience,” Dr. Cheifetz said. “This shift allows us to reach more individuals earlier, strengthen continuity of care, and improve health outcomes across the communities we serve.”
The redesign takes a different form at federally qualified health centers, where assumptions about access have long been more fragile. Melvin Price, DPM, president and CEO of MCR Health in Bradenton, Fla., describes a realization that even opening a clinic is not sufficient. Transportation, geography, awareness and trust are barriers that a building alone cannot overcome.
“That has pushed us to think differently about how we show up in the communities we serve, through stronger community partnerships, outreach, mobile services, technology and new models of care that bring MCR closer to our patients,” said Dr. Price. “We are shifting from expecting communities to find their way to healthcare to asking how healthcare can better find its way to them. For MCR, sustainable growth and better outcomes will come from earning trust, removing barriers and becoming an even more connected part of the communities we serve.”
