Patient-Centered Primary Care Is Gaining Ground

Public and private payers are starting to embrace primary care and the patient-centered medical home as keys to improving health care quality and reducing costs, said outgoing AAFP President Rick Kellerman, M.D., of Wichita, Kan., in a speech during the opening session of the Congress of Delegates here on Oct. 1.

Kellerman cited the formation of the Patient Centered Primary Care Collaborative, or PCPCC, earlier this year as an example of how the private sector has started to "promote the value of primary care in an improved and reformed health care system."

The AAFP and other physician-led organizations started the PCPCC, which promotes primary care and the patient-centered medical home, with a number of large employers, including IBM. In recent months, AARP, General Motors, the ERISA Industry Committee and the National Business Group on Health have joined the collaborative, emphasizing the growing interest in these key issues.

"In fact, the National Business Group on Health has a policy that says primary care is 'foundational' to a well-functioning quality health care system," said Kellerman, speaking before about 245 delegates and alternative delegates. "Others are starting to sing our song."

He also referred to a report released by the Commonwealth Fund in June that said only two things can reduce ethnic and racial disparities in the health care system -- insurance coverage and access to a patient-centered medical home.

"The Commonwealth Fund is singing our song," said Kellerman.

At the same time, the medical home is "capturing the imagination of legislators," he added. For example, Kellerman said that when AAFP leaders met with members of the Senate Finance Committee last month in Washington to discuss reauthorization of the State Children's Health Insurance Program, the Academy representatives were asked about the medical home in every office.

"We didn't bring it up," he stressed. "They asked us. They wanted to know the criteria (needed) to be a medical home. They wanted to know how the payment would work. They wanted to know what a care management fee would cover. They wanted to know how a primary care-based health care system would improve quality and access and help control costs."

"Ladies and gentlemen, they are looking for a way to sing our song," said Kellerman.

He also acknowledged, however, that proponents have a long way to go in promoting the medical home model. "We have many hurdles and speed bumps and, inevitably, there will be detours on the road ahead," Kellerman said. But he urged Academy members to "own the medical home" and to make sure it "isn't hijacked and confused and demeaned."

"Our next step is to operationalize the medical home model," said Kellerman. "And that is where we need to change. It is clear that employers will not pay more for what they are getting now. We must re-engineer our practices, and we must re-engineer our residency programs."

Kellerman noted that the Academy must "tell and sell our message," pointing out that the presidential election campaign is a "critical time for our specialty and our patients."

"We will be devoting specific Academy financial reserve funds during the next 18 months to help the presidential candidates and the public understand the value of primary care," Kellerman added.