Primary Care Assumes Prominent Role in Candidates' Health Care Reform Plans

Although the respective health care plans proposed by presidential candidates Sen. John McCain, R-Ariz., and Sen. Barack Obama, D-Ill., each provide a different direction and focus for health care reform, both plans recognize the importance of primary care in any major reform effort.

"We are hearing from both candidates about the need to improve primary care, the need for preventive services and chronic care management," says AAFP Board Chair Jim King, M.D., of Selmer, Tenn. "All of these things are elements of the patient-centered medical home."

"We are excited by that," he adds.

Len Nichols, Ph.D., a health care economist and director of the health policy program for the New America Foundation, agrees with King's assessment, saying the "medical home is consistent with the spirit of where both candidates are headed."

"Regardless of who wins, I think we will be talking about the medical home going forward," he says.

McCain's health care reform proposal supports new treatment models with respect to chronic disease, calling for payment reforms of Medicare and TRICARE, the U.S. military's health care plan, by compensating providers for diagnosis, prevention and care coordination, according to a comparison of the candidates' health care plans compiled by the AAFP's Government Relations Division. Obama's plan would support health care providers who implement care management programs and encourage team care through medical home models.

"Sen. Obama has long spoken about the fact that our system has become more modeled on acute care versus prevention, and he addresses prevention in a number of ways," says Neera Tanden, domestic policy director for the Obama campaign.

For example, Obama's proposal would require insurers to pay for prevention, cancer screenings, and diagnostic tests in an attempt to keep people healthy rather than "paying for coverage when they are sick," says Tanden. Obama's plan also calls for strengthening the primary care workforce through loan repayment and training programs, along with improved payment for primary care physicians.

The McCain and Obama plans also recognize the need for health information technology, or HIT. McCain's plan, for example, calls for the rapid deployment of information systems, but it does not specify how this will be accomplished. (McCain's campaign did not respond to repeated requests for an interview.)

The Obama plan pledges $50 billion during the next five years to foster widespread adoption of standards-based information technology, according to the AAFP summary.

King stresses that small practices are going to need help from the federal government to implement and maintain electronic health records, or EHRs. During the past few years, family physicians have made tremendous strides in adopting EHRs -- 44 percent of family physicians now have EHRs, and 50 percent expect to have them by the end of the year, King says.

King also notes that small and solo practices are going to need help from the federal government to make HIT connectivity available and affordable. "Even though you may have a great electronic health record, if you cannot talk to your hospital or if you cannot talk to your subspecialist so we can share information, then we haven't accomplished our main need," he says.

The AAFP, meanwhile, is "willing, available and ready to sit at the table with whoever is in the White House next year to work on health improvements in the health care system," King says.