Specialty, Health System Must Change So Patients Can Have Medical Homes

The times, they are a-changin', so get on the bandwagon! That was the message from AAFP President Rick Kellerman, M.D., of Wichita, Kan., May 5 when he described the ways family medicine and the health care system need to change for every American to have a personal medical home.

Kellerman also reviewed the Academy's progress in public-sector and private-sector advocacy and in developing pragmatic tools for family physicians, during his report to participants at the Annual Leadership Forum and National Conference of Special Constituencies here.

That progress includes greater visibility on Capitol Hill, in corporate boardrooms and among health insurers. It also encompasses new knowledge garnered by TransforMED and Preparing the Personal Physician for Practice, or P4.

Family medicine launched its move toward change with a national demonstration project overseen by TransforMED, the AAFP's practice redesign initiative. Then, last spring, the Association of Family Medicine Residency Directors and the American Board of Family Medicine launched P4, which is staffed by TransforMED, to implement and test new residency training innovations. Both projects will provide a roadmap for family medicine practices and residency programs that plan to implement new model of care elements -- such as open access, electronic health records, group visits and electronic visits -- envisioned in the Future of Family Medicine Project report.

In addition, new Academy resources have helped family physicians adapt to and even mold change. Those resources include the Family Practice Management tool kit on retail health clinics (Members Only) and the Value of Family Medicine resource center.

"The Value of Family Medicine (resource center) has more than 100 articles on the value of primary care and family medicine," said Kellerman. The articles substantiate the relationship between a primary care-based health system and improved outcomes at less cost, and they can be useful in discussions with insurers, employers, lawmakers and health policy makers. "Read those articles. Get up to date. You've got to do that, because we have to tell people our story," Kellerman added.

Several businesses have heard the story, and the National Business Group on Health, a not-for-profit organization representing more than 200 large employers, has called primary care "foundational" to a well-functioning health care system, said Kellerman. Many corporations, such as IBM, Wal-Mart, Google and Revolution Health Group, are seeking AAFP input. IBM, which approached the Academy for help in designing a primary care-based health care system for its employees, has discussed its vision with other large employers.

In addition, Revolution Health Group -- a Washington, D.C.-based organization founded by America Online co-founder Steve Case that has fielded a comprehensive online health and medical information site -- sought AAFP's partnership in the recent launch of Revolution's new Web site.

The Academy also has seen improvement in the payment environment, said Kellerman. As a result of ongoing pressure from the AAFP and its primary care colleagues, CMS has updated work relative value units, or RVUs, for CPT codes 99213 and 99214. Complementing its public advocacy efforts, the Academy proactively notified private-sector payers that they should not reduce payment formula conversion factors, a move that could negate the increase in RVUs. Kellerman warned, however, that organized medicine faces a significant challenge in convincing Congress to overhaul the sustainable growth rate formula used to calculate Medicare payments.

Federal lawmakers are seeking Academy input on legislation affecting primary care, and members have the chance to become involved, said Kellerman. Among those options is becoming part of the AAFP key contact program, a proactive and strategic grassroots advocacy initiative in which physician members develop a strong one-to-one relationship with their U.S. congressmen or senators. Kellerman also urged members to support FamMedPAC, the Academy's federal political action committee, which has raised the AAFP's visibility on Capitol Hill.