Prospective family physicians who are wondering about their role in an increasingly complex health care system, take note: According to one health policy expert, you are the hope for transformation of health care in the United States.
Primary care is playing a pivotal role in new and innovative health care delivery models, says health policy expert Paul Grundy, M.D. Grundy delivered the Opening Session Main Stage lecture at the 2014 AAFP National Conference of Family Medicine Residents and Medical Students.
During the 2014 AAFP National Conference of Family Medicine Residents and Medical Students held here Aug. 7-9, Opening Session speaker Paul Grundy, M.D., M.P.H., passionately addressed how new care delivery methods are changing medicine and placing the family physician at the forefront of care. He pointed out that advances in medicine made since Abraham Flexner's era have created a maze of complexity that frustrates physicians and does not improve health outcomes.
"As the level of knowledge increased, we've subspecialized and subspecialized more," said Grundy. "We reached a point where we can't connect the dots."
Yet despite those hurdles, patients continue to view their relationship with their primary care physician as one of the most important in their lives. "You are the second most trusted member of society," he said. "Family is No. 1 and the healer is No. 2."
Grundy, who is IBM's director of global health care transformation and founding president of the Patient-Centered Primary Care Collaborative(www.pcpcc.org), sought to encourage residents and medical students who face the daunting task of navigating patient care in an increasingly fractured health care environment. One key message he highlighted: Don't feel inferior to subspecialists.
- A health policy expert who spoke during the 2014 AAFP National Conference of Family Medicine Residents and Medical Students told future family physicians that they are the hope for improved health outcomes in the future.
- Communities that invest heavily in primary care and develop an integrated system to assist patient care see better health outcomes.
- A patient-centered medical home in Vermont reported huge gains in improving diabetes care management.
"You have no sense of how powerful you are," Grundy told them. He urged these future family physicians to think of themselves as the bridge between patients and the entire spectrum of care. However, he added, for family physicians to continue to serve as the focal point of care delivery, they need to take responsibility for all aspects of patient care; they need to become "comprehensivists."
A major problem with care delivery is the lack of organization and follow-up with patients, said Grundy. A veterinarian's office is more likely to send reminders that a family pet needs its annual vaccinations than a physician's office is to contact a woman who is overdue for a mammogram.
According to a recent Forbes magazine report, 14 percent of physician payments currently are not paid according to the traditional fee-for-service model, and that figure is expected to rise to 20 percent next year, said Grundy. Medicine has to move away from purchasing episodes of care from subspecialists and continue to develop a comprehensive care model in which the primary care physician and his or her team help patients make better decisions that enable them to live healthier lives.
"It's no longer acceptable to deliver an episode of care," he said. "You have to deliver care whether the patient visits or not."
Passage of the Patient Protection and Affordable Care Act has encouraged development and adoption of new models of care delivery, including the patient-centered medical home (PCMH), which emphasizes primary care and regular contact with patients. According to Grundy, communities that invest heavily in primary care are reporting the highest rates of success in reducing hospital visits and lowering costs.
Grundy described how in some areas, the entire community bands together to improve the health of its residents. Nationally, Ogden, Utah, and Dubuque, Iowa, are considered the excellent areas to receive high-quality, low-cost health care. Both communities invest heavily in primary care and utilize an integrated system. Other jurisdictions are following suit, as legislators in Rhode Island, for example, recently passed a law calling for increased spending on primary care.
A community health approach is also working effectively in places such as St. Johnsbury, Vt., where 2 cents from all sick care is transferred to community care. St. Johnsbury hosts a certified PCMH and is one of several health services areas included in the Vermont Blueprint for Health program.
The statewide initiative moves beyond the traditional model of disease management by linking institutions as diverse as community health centers, law enforcement and social services to assist with patient care. All major sectors in the community are involved, including the sheriff’s office and the local Goodwill Industries International Inc. facility, which provides clothing for low-income patients.
When it comes to managing patients with diabetes, for example, a community care coordinator holds monthly meetings to discuss care for all patients, said Grundy. The health center schedules wellness events so patients with the disease can meet with a nutritionist one day and join a hiking group the next. And one day each week, a green grocer visits the community. In addition to helping relieve the burden on primary care physicians, this community approach has resulted in a 60 percent reduction in complications associated with diabetes.
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