Primary Care for the 21st Century: Our Primary Care System is Changing

Health care as Americans know it is undergoing fundamental change. This change is not just in public policy, in covering more of the uninsured, in technology, or in the health care profession—it is in the delivery of care and in the role of the patient. The United States is moving toward a patient-centered model of care, which is proven to increase quality and cost-effectiveness.⁸ This model is anchored by the patient-centered medical home (PCMH), in which patients have a relationship with a primary care physician-led team who manages their care. Through this approach, an integrated team of professionals and support staff provides care in a practice organized around the patient.⁹ In turn, patients have access to personalized, coordinated, and comprehensive primary care when they need it, when it’s convenient for them, and from the right professional—be it a doctor, nurse, physician assistant, physical therapist, dietitian, or other clinician.

Why now? As Dorrie Fontaine, dean of the University of Virginia’s School of Nursing, recently put it: “nothing in health care is getting less complex.”¹⁰ For frustrated patients, members of the medical community, and payers, the change to a PCMH model is long overdue. Although the term medical home had been used initially by the American Academy of Pediatrics in 1967, the model of care had not been practiced broadly.¹¹ The term medical home was used to describe a partnership approach with families who had children with special health care needs to provide primary care that was accessible, family-centered, coordinated, comprehensive, continuous, compassionate, and culturally effective. Although this idea posed a promising concept, the partnership approach did not take root broadly in primary care practices in the United States for several decades.

A breakthrough for the PCMH came in 2002 when the leadership of seven national family medicine organizations, including the American Academy of Family Physicians (AAFP), recognized “growing frustration among family physicians, confusion among the public about the role of family physicians, and continuing inequities and inefficiencies in the U.S. health care system.”¹² They channeled this frustration into an opportunity to improve the situation and to “shape their own destinies by redesigning their model of practice.”¹³ Together, the organizations initiated the Future of Family Medicine project, “to transform and renew the specialty of family medicine to meet the needs of people and society in a changing environment. The Future of Family Medicine project identified core values, a new model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation.”¹⁴ The proposed new model of practice had characteristics very similar to a PCMH.¹⁵

Today, the PCMH has become a fast-growing model that is redesigning primary care across the country.¹⁶ Successfully piloted in several locations, the PCMH model facilitates improved primary care and will likely become a reality for most Americans in some form in the next decade. The Institute of Medicine (IOM) has developed a commonly accepted definition of primary care: “Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community” (IOM, 1996). The term “integrated” in the IOM definition encompasses “the provision of comprehensive, coordinated, and continuous services that provide a seamless process of care.”

For the PCMH to become a reality, primary care practices must provide and perform as the strong foundation where medical homes reside. Not surprisingly, many U.S. primary care practices several years ago were not immediately able to perform as a medical home. However, organizations such as the AAFP and others have spent roughly eight years working to help physicians and their teams make the change. In 2005, the AAFP created TransforMED to provide best practices, educational seminars, guidelines, launch tips, principles, research, online courses, step-by-step explanations, training programs, and webinars. The AAFP offers family physicians and their teams the tools they need to transform their practices into medical homes. The mission of TransforMED is nothing less than the transformation of health care delivery to achieve optimal patient care, professional satisfaction, and the success of 21st century primary care practices.

Next: About the PCMH