Speaker Says Primary Care Physicians Should Drive Health Care Reform

Family physicians must work with local employers and business coalitions to promote the patient-centered medical home because most of the nation's small businesses are unaware of the model and require "communication on the community level," said Paul Grundy, M.D., director of health care for IBM, during a question-and-answer session at the AAFP's Annual Leadership Forum, or ALF, here on May 2.

Family physicians should attend business meetings to make business leaders aware that physicians are driving health care reform, said Grundy. "You are going to have to take responsibility for that," he told attendees. "You know these local companies better than we do. When they start to hear about the (patient-centered medical home) they get pretty excited, and they see some alternatives."

Grundy also recommended that physicians adopt strategies from TransforMED and the Patient-Centered Primary Care Collaborative, or PCPCC, to transform into patient-centered medical homes. The PCPCC recently developed a guideline for employer purchasers of health care, said Grundy, who is chair of the collaborative. This document puts the "language of what (employers) want to buy into (physicians') hands."

Ariel Smits, M.D., of Portland, Ore., said her state is in the process of reforming its health care system to require residents to carry insurance. She asked Grundy if he thought residents would actually use patient-centered medical homes if officials incorporated them into the state's health care plan.

"You need a denominator of physicians who are ready to start moving to transform their practices," Grundy responded. "There is no point in having any further conversation from the standpoint of pilot design unless there is a nucleus, a core of physicians who are ready to start going down the road of transforming their practices."

In response to another question, Grundy said "a few people who are grouped together in a common cause can make a huge difference." As an example, he cited the PCPCC, which began in early 2007 with a handful of physician groups, including the AAFP; health care organizations; and employers. These founding organizations have since turned the PCPCC into one of the country's largest and most powerful primary care collaboratives, creating "phenomenal momentum," in the process, said Grundy.

In Memphis, Tenn., some health plans are preparing to launch a medical home pilot project, and Lee Carter, M.D., of Huntingdon, Tenn., expressed concern that some of the large academic medical centers would hijack the process by proclaiming themselves medical homes. "How do we keep the big health care entities that are in these large regions from seeing this as a big cash cow for them?" asked Carter.

Grundy responded by picking up a chair and placing it in the middle of the room. "I pick up a chair and put it in the middle of the room and say, 'That is the patient -- that is who is at the center of this conversation,'" Grundy said. "Let's start with what we know is the right thing to do for that patient."

Grundy also noted that most subspecialists, or partialists, want primary care physicians to "do comprehensive care to free them up to do the part of care they want to do." Grundy noted that a transplant surgeon could not qualify as a patient-centered medical home because the surgeon does not provide comprehensive care; however, an infectious disease physician taking care of a patient with HIV could potentially qualify by providing comprehensive care for the patient's HIV disease, Grundy said.