Environmental Scan Points to Importance of FFM’s New Model of Care

The Future of Family Medicine Project report was right. The report, which has set the agenda for family medicine since 2004, outlined a model of care that would respond to Americans' growing demand for health care that offers convenience, restrains cost increases and ensures continuity of care.

Now, according to the 2007 Environmental Scan presented to the AAFP Board of Directors in late November and available for Academy members to review online, the FFM report's predictions are coming to pass. Patients and those who pay for their care are demanding convenience, access, price transparency and demonstration of quality.

The scan provides a third-party view of the environment in which medicine is practiced. This year's message is that the marketplace and patient preferences will have a growing influence on the health care system, said David Mitchell, a partner at Washington, D.C.-based GMMB, which was contracted by the Academy to conduct the environmental scan. The likely impact of those combined factors gives family medicine an opportunity to position itself as a solution to rising costs, fragmented care and poor outcomes, said Mitchell.

AAFP President Rick Kellerman, M.D., of Wichita, Kan., agreed. Family medicine must help patients, employers and insurance companies understand that a primary care-based health care system will resolve many of the issues in the current “dysfunctional, underperforming system,” he said. “Family physicians are on the front lines of the dysfunction. We see it first and feel it the most. We’re where the rubber hits the road, and right now, it is a rocky road!”

Rising cost is the biggest factor driving the shift to consumerism in health care, according to the scan. Citing data from the Kaiser Family Foundation's 2006 Employer Health Benefits Survey, (PDF file: 8 pages / 480 KB. More about PDFs.) the scan noted that insurance premiums for family coverage have increased by 87 percent since 2000. Annual worker contributions have increased by $293 to $627 a year for single coverage and by $1,354 to $2,973 a year for family coverage during the same period.

Such cost pressures reinforce the advantages of having a family physician, said Kellerman. Research consistently shows that health care costs are lower and health outcomes are higher in primary care-based systems, he noted. That message would resonate well in a market in which, according to research conducted by the Future of Family Medicine Project, Americans prefer a personal physician in a medical home.

Family medicine must communicate to the public, employers, insurers and health policy-makers that family physicians provide a medical home and save money, said Kellerman. “When you talk to family physicians in other developed countries, they are in a better position of strength because their health care systems are based on primary care,” he said, recounting recent conversations he had with members of the College of Family Physicians of Canada.

However, a primary care-based structure must be accompanied by family physicians’ implementation of the new model of care if they are to compete successfully in the health care marketplace, say analysts. As Americans bear more of their health care expenses, they seek no- or low-cost services that accommodate the time demands of work and family, said Mitchell.

"The consumers and payers are going to increasingly have options for preventive and primary care,” he said. “The service the family physician provides through traditional family medicine practice will become increasingly available from other places, such as retail clinics, worksite clinics and even self-management.”

True. Since their inception in 2003, retail health clinics have spread across the country, according to the environmental scan. Fifteen companies now offer a total of more than 260 retail health clinics across the country.

In addition, Americans are getting more of their health-related information online. Eighty percent of Americans have accessed the Internet for health care-related information, according to the Pew Internet and American Life Project report, “Online Health Search 2006," (PDF file: 22 pages/ 112 KB. More about PDFs.) published Oct. 29.

American corporations also are taking action; 25 percent of Fortune 1000 companies are offering or planning on-site primary care clinics by the end of 2007, according to the scan. By next year, 54 percent of the largest U.S. employers will offer some version of health coaching to employees.

The new model of care can help family physicians get ahead of these and other marketplace trends. Elements such as open-access scheduling, physician practice Web sites that provide general and patient-specific information, e-mail communication, and working closely with local companies in the community can position family physicians to thrive in such a market-driven environment.

Family physicians have several resources for implementing elements of the new model of care. TransforMED, a division of the Academy that focuses on transformative practice redesign, offers a number of tips gleaned from its pilot projects, as well as other information. In addition, the Institute for Healthcare Improvement, a not-for-profit organization focused on improving health care systems, offers information on enhancing quality of care for patients with chronic conditions and primary care access.

Also available is "The New Model of Family Medicine: What's In It For You," a Family Practice Management article by Bruce Bagley, M.D., AAFP medical director of quality improvement. The article discusses several elements of the new model, including team care, planned care, open access, redesigned office systems, electronic technology and quality improvement.