Wanted: Champions of family medicine for improved U.S. healthcare
Family medicine needs influential, aggressive allies, according to a commentary by Mary Nolan Hall, MD, and Jerry Kruse, MD, along with the Association of Departments of Family Medicine, that was published in the January/February edition of Annals of Family Medicine.
“For decades, academic and organized medicine, the government, insurers, and consumers of healthcare have shown little interest in the development of an effective, efficient and equitable healthcare system,” the authors wrote.
In 2006, a group of large employers, led by IBM, formed the Patient-Centered Primary Care Collaborative (PCPCC), a coalition of consumer groups, quality organizations, health plans, labor unions and physician groups to advance the principles of the Patient-Centered Medical Home (PCMH) and advocate for a model of healthcare compensation with the appropriate incentives, they said.
“ADFM has joined the AAFP and the other members of the PCPCC, who are united in the belief that primary care is the foundation of a high-performing healthcare system and that the PCMH is the key organizational construct to improve care coordination, advance the meaningful use of electronic health records, enhance access and simultaneously improve outcomes and lower costs,” the authors stated.
ADFM holds positions on the advisory and legislative committees of the PCPCC. The collaborative is an important ally in ADFM’s advocacy efforts, they said.
The members of the PCPCC were encouraged that the Senate health reform bills reported out of the Finance Committee and the Committee on Health Education Labor and Pensions (HELP) include these provisions that emphasize a foundation of primary care:
1. A Medicaid state plan option in which enrollees with at least two chronic conditions can designate a primary care provider in a PCMH.
2. A CMS Innovation Center authorized to test, evaluate, and expand new payment structures that will foster patient-centered care, improve quality and slow the rate of Medicare cost increase.
3. A 10 percent bonus for primary care practitioners.
4. Medicare direct and indirect Graduate Medical Education funding for Teaching Health Centers (i.e., GME funding that is paid directly to non-hospital entities to foster education in outpatient and community venues).
Further, the PCPCC was concerned that the legislation included only high-need, high-cost patients and ignored the fact that the entire population is benefited by access to primary care. In an excerpt from the letter, the Senators were reminded that “a guiding principle of the PCMH is that comprehensive, continuous, coordinated and preventive care, managed by a highly trained clinician in a transformed practice, can prevent complications that could result in a patient becoming high-need or high-cost.
"If Congress’ goal is to improve outcomes, lower costs and prevent disease and complications associated with chronic illnesses, as it must be, it would be a missed opportunity to limit PCMH eligibility," Hall and Kruse wrote. "In addition, practices are much more likely to make the investment in practice transformation to become PCMHs if many of their patients are eligible to participate and they will receive care coordination payments for such patients. Furthermore, we have concerns about the feasibility and unintended administrative burden of practices identifying those patients.”
The PCPCC recommended that:
1. Medicare and Medicaid pilots be broadly inclusive of all patients who will benefit from preventive and coordinated care, and not be restricted to “high-cost” or “high-needs” patients.
2. Payment models should recognize differences among the patient populations and the differing needs of care or care coordination.
3. Payment models should include both private and public payers to maximize the impact of the pilot programs for a majority of patients in a practice.
“The PCPCC has begun this foundational work and the voice needs to grow louder,” the authors wrote. “The PCPCC will be most effective when members spur their constituencies to action. Departments of family medicine must not only encourage our own faculties, but must also energize medical schools and academic health centers to join the movement to build a more effective coalition for systemic change.”
“For decades, academic and organized medicine, the government, insurers, and consumers of healthcare have shown little interest in the development of an effective, efficient and equitable healthcare system,” the authors wrote.
In 2006, a group of large employers, led by IBM, formed the Patient-Centered Primary Care Collaborative (PCPCC), a coalition of consumer groups, quality organizations, health plans, labor unions and physician groups to advance the principles of the Patient-Centered Medical Home (PCMH) and advocate for a model of healthcare compensation with the appropriate incentives, they said.
“ADFM has joined the AAFP and the other members of the PCPCC, who are united in the belief that primary care is the foundation of a high-performing healthcare system and that the PCMH is the key organizational construct to improve care coordination, advance the meaningful use of electronic health records, enhance access and simultaneously improve outcomes and lower costs,” the authors stated.
ADFM holds positions on the advisory and legislative committees of the PCPCC. The collaborative is an important ally in ADFM’s advocacy efforts, they said.
The members of the PCPCC were encouraged that the Senate health reform bills reported out of the Finance Committee and the Committee on Health Education Labor and Pensions (HELP) include these provisions that emphasize a foundation of primary care:
1. A Medicaid state plan option in which enrollees with at least two chronic conditions can designate a primary care provider in a PCMH.
2. A CMS Innovation Center authorized to test, evaluate, and expand new payment structures that will foster patient-centered care, improve quality and slow the rate of Medicare cost increase.
3. A 10 percent bonus for primary care practitioners.
4. Medicare direct and indirect Graduate Medical Education funding for Teaching Health Centers (i.e., GME funding that is paid directly to non-hospital entities to foster education in outpatient and community venues).
Further, the PCPCC was concerned that the legislation included only high-need, high-cost patients and ignored the fact that the entire population is benefited by access to primary care. In an excerpt from the letter, the Senators were reminded that “a guiding principle of the PCMH is that comprehensive, continuous, coordinated and preventive care, managed by a highly trained clinician in a transformed practice, can prevent complications that could result in a patient becoming high-need or high-cost.
"If Congress’ goal is to improve outcomes, lower costs and prevent disease and complications associated with chronic illnesses, as it must be, it would be a missed opportunity to limit PCMH eligibility," Hall and Kruse wrote. "In addition, practices are much more likely to make the investment in practice transformation to become PCMHs if many of their patients are eligible to participate and they will receive care coordination payments for such patients. Furthermore, we have concerns about the feasibility and unintended administrative burden of practices identifying those patients.”
The PCPCC recommended that:
1. Medicare and Medicaid pilots be broadly inclusive of all patients who will benefit from preventive and coordinated care, and not be restricted to “high-cost” or “high-needs” patients.
2. Payment models should recognize differences among the patient populations and the differing needs of care or care coordination.
3. Payment models should include both private and public payers to maximize the impact of the pilot programs for a majority of patients in a practice.
“The PCPCC has begun this foundational work and the voice needs to grow louder,” the authors wrote. “The PCPCC will be most effective when members spur their constituencies to action. Departments of family medicine must not only encourage our own faculties, but must also energize medical schools and academic health centers to join the movement to build a more effective coalition for systemic change.”