Since the American Academy of Family Physicians (AAFP) supports quality improvement activities that focus on improving the health of patients, families, and communities, it is the AAFP position that physician networks offered by payers and health systems must provide patients sufficient access to health care, support the physician-patient relationship, and focus on improving patient care.
The long-term value of patients having an ongoing relationship with a personal family physician outweighs the short-term financial benefits of frequent switching of primary care physicians due to tiering, narrowing, or terminating family physicians from networks. A substantial body of evidence demonstrates that continuity of care improves outcomes and decreases unnecessary utilization. Patients who have a higher level of continuity of care have a greater sense of trust in their physician, greater sense of security, and better communication with their physician. In addition, the ongoing relationship with a patient, when there is continuity of care, contributes to greater physician satisfaction. Therefore, substantial caution should be exercised when using systems that disrupt the ongoing patient relationship with their personal physician and cause difficulty with access to continuous and comprehensive care. Steering patients to high quality and/or efficient-designated physicians who are already operating at their practice capacity, may result in interrupted or impeded care, which could be further exacerbated by physician workforce shortages. Thus, health insurers' program must have mechanisms in place to ensure patient access to a primary care physician.
Tiering, narrowing, or executing methodologies and policies are often proprietary and may vary among payers and health systems. Any data methodology used to tier, rate, designate, or exclude family physicians should be transparent and align with AAFP policies on "Physician Performance Measurement and "Transparency."
Attributes of patient steering may also vary, but should maintain the continuity of existing physician patient relationships whenever possible and adhere to the AAFP policies on "Health Care for All," "Performance Measures Criteria," "Physician Profiling," and "Transparency." Patient steering and tiered or narrowed network programs should adhere to the following principles:
(2007) (2019 COD)