AAFP, IBM Team Up to Pitch Family Medicine

For the past several years, the AAFP has spoken out loud and clear about a broken U.S. health care system that dispenses high-cost, low-quality care in an inefficient system driven by subspecialists rather than by family physicians and other primary care physicians.

Finally, someone is listening. IBM, the world's largest information technology company -- with some 329,000 employees in 75 countries -- is working with the Academy to design a health care system that will keep IBM employees healthier and save money.

"This is a watershed, historic moment," said AAFP President Larry Fields, M.D., of Ashland, Ky. "It's the first time a large employer and a medical specialty society have collaborated to design a cost-efficient, quality, affordable health care system for employees."

IBM's Martin Sepulveda, M.D., M.P.H., said part of his job as vice president of global well-being services and global health benefits is to develop policies and strategies to keep IBM employees as fit, productive and innovative as they can be.

"We have a stake in addressing those root causes of the dysfunction in our health care system, and one of the most neglected and glaring root causes of that dysfunction is the crisis in the decline of primary care," he said.

"We're interested in enhancing the frequency and the quality of the interaction between patients and primary care providers," said Sepulveda. "And to do that, you don't go to the insurers, you go to the physician provider."

Fields said since IBM first approached the Academy in March, AAFP leaders have been pumped up. "It's almost indescribable to find someone with all of the experience and expertise that IBM has, who can independently look at what we've been doing and say, 'you're right.'"

This is private sector advocacy at its best, he added.

Family physicians have all the components and all the expertise to deliver the model of care that IBM wants for its employees, said Fields. "We have the expertise in electronic health records, and we have the lifelong learning it takes to keep people up-to-date and on the cutting edge of medicine. We don't have to invent anything, and we don't have to train anybody differently."

Fields said the Academy needs to put all the pieces together and work with IBM to create a model of care that other employers in the marketplace will see and want. "Then the employers will dictate to their insurance companies that this is what they want to buy," said Fields.

To that end, Fields went to Washington, D.C., on Aug. 8 to take the case for the value of family medicine and primary care before a group of physicians and corporate wellness managers at the ORC WorldwideTM Occupational Safety and Health Physicians Group Meeting. At his side was Paul Grundy, M.D., M.P.H., IBM's director of health care, technology and strategic initiatives.

Grundy said the two physicians went to the meeting "to surface this idea among our colleagues," adding that the meeting attendees were some of the top physicians for some of the major companies in the United States, including Bayer, Abbott Laboratories, Dow Corning Corp., General Motors Corp., Honeywell International, Johnson & Johnson, and Walt Disney World Co.

Fields said the presentation was a success. "Those are the big players, and they were extremely interested. They had lots of questions, all of which we had answers to. They realize they've been spending a lot of money and not really getting what they consider value and quality (in health care), and they want to do something different," he said.

As the joint initiative moves forward, Grundy said IBM would reassure employees that the company has no intention of going back to the "gatekeeper" model that primary care providers became mired in a decade ago.

Instead, employees will hear this message: "This isn't about keeping you from seeing anybody you want; this is about providing you with meaningful support in a relationship where you have a medical home that supports you. And, by the way, in that medical home exist your medical records in an electronic format that interfaces with our pharmacy program. And, by the way, your doc is paid to have interactions with you by e-mail."

Grundy said that even before treading this new territory, IBM was ahead of other corporate giants in implementing groundbreaking employee health and wellness programs, including disease management and incentive programs for smoking cessation, exercise and weight loss.

While the company was making progress, "we had to move beyond the low-hanging fruit that we'd already picked," said Grundy.

Sepulveda said the primary care IBM is interested in buying for its beneficiaries "is not the primary care of the past, not the primary care of the present, but the primary care of the future." It's the primary care that family physicians are trained to deliver "but are unable to deliver because of all of the dysfunction in the system," he said.

"Primary care is an abandoned, neglected, incredibly important component of what we're fighting (for) in the health care marketplace," said Sepulveda. IBM has decided to try to create "a momentum for reform and transformation" at least as powerful as the momentum that has been occurring with other health care issues, such as medical errors, transparency, quality measurement, performance and waste, he said.

IBM can't walk away from this "because at the end of the day it's about the people in our enterprise and their ability to be able to perform. This is a big deal for us … it's something that we're passionate about," said Sepulveda.