Kelly Pfeifer, who recently took over as the medical director for the San Francisco Health Plan, knows the problems of medical economics all too well.

“We’ve been spending lots of money for health care and not getting a lot for it,” Pfeifer said at a forum in Sacramento put on by the Center for Health Improvement. “We’ve been paying for volume, not quality, and that’s what we get.”

Pfeifer also said she knows a few solutions for medicine’s troubles. “I do have hope that we can get out of this mess,” she said. “The answer is to invest in primary care.” Pfeifer had several examples of primary care innovations that have shown promise.

At the Chinatown Public Health Center, there was a problem with how new immigrants get help. There were so many new patients with complicated and similar problems it was unclear how each of them could be helped through the clinic’s system.

So the Chinatown center came up with a new approach: “They needed to see a doctor, fill a prescription, get the tests they needed, and so we did it as group appointment,” Pfeifer said.

The clinic standardized the way services are introduced to patients. All new patients are required to attend a group orientation session, where nurses take vital signs, order tests and a physician reviews the chart. That sets patients along the right path toward a personal health plan, in a more efficient way.

Pfeifer is keeping tabs on innovations in health centers throughout the state .

The Ocean Park Health Center in San Francisco has expanded the role of the medical assistant. The Shasta Consortium of Community Health Centers in Northern California has instituted a telemedicine program that is a leader in the field, she said, even including behavioral health treatment.

“Yester-care is where we are, and future care is where we need to go,” Pfeifer said. “It’s no longer all about the doctor. You need to focus on the patient experience.”