America's health care system would take a U-turn and focus reform efforts on patient care rather than on payer systems under a plan approved by the AAFP Congress of Delegates Oct. 3.
Congress of Delegates Adopts 'Health Care for Everyone' Plan
By Leslie Champlin
• Chicago
10/3/2007
The plan, dubbed "Health Care for Everyone," calls for a primary health care-based system in which all Americans have a medical home. By providing comprehensive preventive, acute and chronic care and by serving as a gateway for subspecialist services, the medical home will reduce costs, enhance care and improve outcomes, the plan says.
"The AAFP plan centers on the principle that everyone in the United States should have a patient-centered medical home, preferably from a family physician," said AAFP President Rick Kellerman, M.D., of Wichita, Kan. "America's health care system must have primary care as its foundation, and the patient-centered medical home must be its basic building block."
In response to a directive from the 2005 Congress of Delegates, the AAFP Board of Directors last year appointed a task force to update the Academy's health care coverage for all policy. That update came to the Board of Directors in the task force's report, which noted, "It has become apparent that perpetuating a system of uncoordinated, fragmented care, emphasizing intervention rather than prevention and comprehensive management of health, will perpetuate the crisis of uncontrollable system costs, without concomitant improvement in quality. … The key to change, we believe, is the patient-centered medical home."
Under the plan, all Americans would be eligible for primary care, prenatal care, well-child visits, immunizations and other evidence-based preventive services, and hospice care without copayments or deductibles. Other health services -- medications, hospitalizations, durable medical equipment, emergency department visits, consultations and referrals, diagnostic tests and procedures not performed in the medical home, and long-term care -- would be paid on a fee-for-service basis and subject to copayments and deductibles. Catastrophic financial protection would kick in when patients' costs reached a certain threshold, such as $5,000 per family per calendar year.
In addition, family physicians and their primary care counterparts whose practices qualify as medical homes would receive a per-member, per-month fee to support the additional time, infrastructure and administrative work inherent in being a medical home, according to the plan.
Providing primary care-based services to all Americans would cost $47.5 billion per year, according to an analysis by the Lewin Group. However, that additional cost would be partially offset by $15.5 billion in savings as a result of less duplication and administrative overhead, more care coordination, and better prevention and outcomes.
"Ultimately, the goal is to ensure the good health of all Americans. Simply having an insurance card does not guarantee that," said Kellerman. "That card must be accompanied by a health care system that offers a medical home, where people can develop a relationship with their doctors, work to prevent illness, and get high-quality care when they become sick or injured. Insurance without access to a physician won't solve the problem. This plan ensures that health care is available when Americans need it."
"The AAFP plan centers on the principle that everyone in the United States should have a patient-centered medical home, preferably from a family physician," said AAFP President Rick Kellerman, M.D., of Wichita, Kan. "America's health care system must have primary care as its foundation, and the patient-centered medical home must be its basic building block."
In response to a directive from the 2005 Congress of Delegates, the AAFP Board of Directors last year appointed a task force to update the Academy's health care coverage for all policy. That update came to the Board of Directors in the task force's report, which noted, "It has become apparent that perpetuating a system of uncoordinated, fragmented care, emphasizing intervention rather than prevention and comprehensive management of health, will perpetuate the crisis of uncontrollable system costs, without concomitant improvement in quality. … The key to change, we believe, is the patient-centered medical home."
Under the plan, all Americans would be eligible for primary care, prenatal care, well-child visits, immunizations and other evidence-based preventive services, and hospice care without copayments or deductibles. Other health services -- medications, hospitalizations, durable medical equipment, emergency department visits, consultations and referrals, diagnostic tests and procedures not performed in the medical home, and long-term care -- would be paid on a fee-for-service basis and subject to copayments and deductibles. Catastrophic financial protection would kick in when patients' costs reached a certain threshold, such as $5,000 per family per calendar year.
In addition, family physicians and their primary care counterparts whose practices qualify as medical homes would receive a per-member, per-month fee to support the additional time, infrastructure and administrative work inherent in being a medical home, according to the plan.
Providing primary care-based services to all Americans would cost $47.5 billion per year, according to an analysis by the Lewin Group. However, that additional cost would be partially offset by $15.5 billion in savings as a result of less duplication and administrative overhead, more care coordination, and better prevention and outcomes.
"Ultimately, the goal is to ensure the good health of all Americans. Simply having an insurance card does not guarantee that," said Kellerman. "That card must be accompanied by a health care system that offers a medical home, where people can develop a relationship with their doctors, work to prevent illness, and get high-quality care when they become sick or injured. Insurance without access to a physician won't solve the problem. This plan ensures that health care is available when Americans need it."
News From 2007 Annual Assembly