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Tuesday Aug 06, 2019

Celebrating Disruptive Innovators in Primary Care

"See your future. Be your future. Make, make it. Make your future."
-- Chevy Chase's character, Ty Webb, in
Caddyshack

[signs going in different directions]

I hope everyone is having a nice summer. Washington, D.C., has emptied for the summer recess and likely will remain relatively quiet for the next five weeks until Congress' expected return around Sept. 9. Then the fall legislative agenda will be busy for the AAFP, with several health care items pending.

At the top of our to-do list is making sure the Teaching Health Center Graduate Medical Education Program is reauthorized and funded. If you haven't already done so, please use our Speak Out tool to send a letter to your elected officials urging them to support the program.

We also will be working to pass several other policies related to reducing the administrative complexity of and improving payment systems under the Medicare Access and CHIP Reauthorization Act. Much more to come on these items in future posts.

Also, many of you are likely aware that CMS has published the proposed 2020 Medicare physician fee schedule. The AAFP has published a summary,(4 page PDF) which provides a quick snapshot of the key details. I will write more about the fee schedule in my Aug. 20 post.

The quote at the beginning of this post is from the classic movie Caddyshack. It was delivered to young caddy Danny Noonan, who was on the verge of defeating the establishment bully Judge Smails at the local golf club, thus upending the status quo. The scene concludes with Danny rising to the moment and changing the course of his future.

I have been studying the health care system, specifically primary care, for more than 20 years. It is easy to focus our attention on what is wrong with our health care system or the challenges facing family medicine. Although I am the first to admit that our health care system has its flaws and our discipline certainly faces its challenges, I think it is important for us to focus on the fact that the innovations taking place in family medicine and primary care are exciting. What's more exciting to me is the fact that many of these disruptive innovations are being created and led by family physicians.

During the past few years, I have become increasingly excited by the "disrupters" in primary care. This week, I will focus on a few family medicine/primary care disrupters and celebrate some of family medicine's own Danny Noonans who are taking on the establishment bullies to provide high-quality primary care to patients.

Here are four examples:

  • In the early to mid-2000s, a group of family physicians began challenging the legacy business model that called for physicians to rely on contractual arrangements with insurance companies as the foundation of their practices. Instead, these disrupters identified a financial arrangement that allowed patients to directly purchase primary care services on a membership basis. This model of primary care aims to remove the complex third-party relationships and focus solely on the patient-physician relationship. The direct primary care movement has produced many family physician leaders (many of whom are active in the AAFP's DPC member interest group). One of the most prominent leaders of the DPC movement and community is a collaborator with the AAFP on the DPC Summit.(www.dpcsummit.org) Her name is Julie Gunther, M.D., and she is a family physician.
  • Recognizing that many individuals with complex medical needs faced barriers to obtaining office-based primary care, an innovative group of physicians formed the Home Centered Care Institute,(www.hccinstitute.org) which is based in Schaumburg, Ill. HCCI is designed to promote payment and delivery models that support home-based primary care for the nation's more than 4 million vulnerable patients with complex medical needs. Today, the HCCI and HBPC movement is led by family physician Thomas Cornwell, M.D. Here is a great AAFP News article about Dr. Cornwell.
  • About four years ago, the leadership of a small group of family physicians led independent, largely rural family medicine practices in southeast Nebraska to establish Think Whole Person Healthcare, one of the most successful accountable care organizations in the nation.(www.prnewswire.com) One of the leaders of this movement and a contributor to its success is family physician Joe Miller, M.D.
  • In 2006, driven by the alignment of two community hospitals, the Cambridge Health Alliance(www.challiance.org) in Massachusetts was born. Built on a commitment to provide comprehensive primary care and public health services to the community, the CHA extends its work beyond the exam room to align with that of numerous community programs. The alliance's work to remove barriers to care, improve the health status of its patients and focus on addressing the underlying social determinants of health is innovative and offers a model for others. The alliance also is training the next generation of family physicians. There are numerous people that have made CHA successful, but one of them is CHA chief of family medicine Laura Sullivan, M.D.(www.challiance.org)

Each of these models is unique, but they have a few things in common:

  • Each model has taken aggressive steps to enhance access to its practices. To truly create a longitudinal relationship with patients and populations, the practices have made it easier for patients to reach physicians and primary care services. This access comes in the form of extended hours, walk-in appointments, home visits, e-visits and real-time access to a physician via phone or email.
  • They aggressively pursue continuity with the family physician and primary care teams. Each of these examples has a unique method for maintaining continuity, but they all focus on making sure their patients have a continuous relationship with a family physician and/or primary care team.
  • Each model has expanded the scope of family medicine and the services provided to be more comprehensive. These models recognize that a more comprehensive set of services enhances the patient experience and reduces leakage to other specialties, which enhances continuity.
  • Each of these models coordinates care for patients across the health care spectrum -- subspecialists, hospitals, pharmacy, therapy, etc. There is a concerted effort to help patients navigate the health care system. In the case of Cambridge Health Alliance, it has expanded this coordination to include a much broader range of community-based services.

Important Note

I wrote this post to emphasize the leadership of family physicians in developing innovative and disruptive models of care that challenge the status quo. It is by no means an exhaustive accounting of family medicine/primary care innovations. It is a sampling.

And I certainly do not intend for this post to be interpreted as a slam on the status quo, per se. There are tens of thousands of family physicians who are providing high-quality primary care to their patients and communities in a variety of practice settings/styles. They are innovative inside their practices, and they, too, address access, continuity, scope and care coordination. We celebrate these models of care delivery, as well, and the AAFP is here to support all members, regardless of their practice setting/style.

I hope you enjoy the final weeks of summer and are planning to join us in Philadelphia in September for the Family Medicine Experience.  

Wonk Hard -- Celebrating A Job Well Done!

In the coming weeks, the AAFP will say goodbye to one of its most accomplished and impactful employees and advocates. After 30 years of stellar service to the Academy, Jane Krieger is retiring. I am beyond happy for Jane, but I am saddened to lose her as a colleague and collaborator. Jane's leadership of the Practice Advancement Division and her service on the Commission on Quality and Practice have contributed to numerous achievements and the betterment of family medicine. We at the AAFP are spending August celebrating Jane's great career and her friendship, and we wish her well in retirement.

Posted at 09:51AM Aug 06, 2019 by Shawn Martin

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Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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