Continuing Conversation Reaps Rewards

In an effort to keep the lines of communication open on issues that affect family physicians and their patients, Academy leaders and staff members traveled to Louisville, Ky., Oct. 19 to meet with members of Humana's leadership team.

It was the first "away" meeting in the "home-and-away series" of meetings the Academy began in the spring of 2005 with some of the country's major insurance providers, including Humana. The initial meetings have taken place at Academy headquarters in Leawood, Kan., and follow-up meetings have been scheduled on the respective companies' home turfs.

Tom James, M.D., Humana's national accounts health care adviser and convener of the meeting, said in an interview after the meeting that establishing ongoing two-way communication between Humana and the Academy could reap benefits all around. "No health insurance company can provide health care benefits in a vacuum without understanding the basis of clinical practice," he said. Similarly, the insurance company brings to the table "a global view of utilization and cost factors that can help as the Academy looks to address the health care issues of this country."

AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., led the Academy team, which included Bruce Bagley, M.D., AAFP's medical director of quality improvement and other staff members from the Academy's Practice Support Division.

"We framed the meeting in Louisville around our three pillars for health care reform: increasing the family medicine work force, changing the payment systems to create such a work force, and liability reform," said Fields after the meeting. Much of the meeting was spent discussing ways to promote such changes with all parties working together, he added.

Discussion centered on issues introduced during a meeting of the two organizations at AAFP headquarters last spring, including

James singled out retail health clinics as an issue where the AAFP and Humana have had good "give-and-take" discussions. Based on discussions with the Academy and a shared concern about the value of continuity of care, James said Humana has set a higher patient copay for health care provided at retail clinics versus care provided by patients' primary care physicians.

Even though Humana customers are demanding the convenience factor that retail clinics provide, "we've been able to go back to those customers and say, 'Here's what the American Academy of Family Physicians has told us about the health care value of continuity of care,'" said James.

Significantly, the American Board of Family Medicine -- represented by ABFM President and CEO James Puffer, M.D. -- also had a presence at the meeting. "This was a historic meeting because, for the first time, the AAFP, the ABFM and an insurance company all came together to improve the lot of family doctors and the patients we serve," said Fields.

Puffer said after the meeting that ABFM has had discussions with a number of payers to discuss ways in which ABFM's Maintenance of Certification Program for Family Physicians can interface with pay-for-performance initiatives that are being introduced by payers across the country. He said his organization has worked on the issue with the American Board of Internal Medicine and American Board of Pediatrics and, more recently, with the AAFP. The Louisville meeting presented an opportunity for ABFM to sit down at the table with the Academy and Humana, he said.

Meeting with insurance companies has been "extremely helpful in educating them about the robust methodology that exists in both ABFM's Performance in Practice Modules and the AAFP's METRIC (Measuring, Evaluating and Translating Research Into Care) modules, and how these tools can be used to initiate quality improvement activities within a physician's office," said Puffer.

On the insurer's side, James said Humana wants to develop a good physician recognition program for physicians who are involved in quality improvement initiatives, "but we really need to have the input from the professional societies as opposed to dreaming up something within the insurance company."