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Tuesday Oct 15, 2019

Advocacy in All Arenas: Making the Case for Family Medicine

"No, I won't smile, but I'll show you my teeth"
-- Halsey

[agenda and numbered list]

It is a joyous time in our nation's capital because the Washington Nationals are playing in the National League Championship Series. Professional sports in Washington, D.C., historically, have been a lot like U.S. politics of late -- rich in drama, poor in results.

Meanwhile, in college sports,(oklahoman.com) there are few things that I enjoy more than knowing that for the next 12 months the Texas Longhorns must sit quietly in their dusty cow town and find solace in their common refrain, "Next year." #BOOMER

Now on to more serious matters.

I frequently write about the AAFP's government-focused advocacy efforts in Washington and in state capitols. We appreciate the support many of you provide those efforts through your engagement with the Family Medicine Action Network and the Family Medicine Political Action Committee (FamMedPAC). Our advocacy efforts on behalf of family medicine are successful because of your support, engagement and commitment.

Although our work with government bodies is critically important, it is not the only advocacy we conduct on behalf of the nation's family physicians.

In this post, I am focusing on the AAFP's private-sector advocacy efforts with commercial insurers and other key players in the health care industry. While our public-sector advocacy is largely managed by our government relations division, our private-sector advocacy is directed by our practice advancement division. A focal point of our private-sector advocacy efforts is the commercial insurers.

Each year, the AAFP conducts face-to-face meetings with the largest national health insurers -- Blue Cross Blue Shield, Humana, Cigna, Anthem, CVS/Aetna, etc. In total, we will meet with five to eight insurers per year on your behalf. Each company has its own leadership structures, but I am pleased to report that almost all companies have a family physician in their medical leadership team, and our engagements are certainly enhanced by the presence of one or more AAFP members.

Meetings with insurers serve multiple purposes for the AAFP. The most important is a direct line of communication with the companies, which enables us to raise issues on your behalf. Although most of you probably have macro-level opinions (positive and negative) of the various insurers in your state, region and community, you likely also have specific, practice-level issues that require attention from time to time. The AAFP, due to our strong working relationships, is able to raise these issues with the insurers and work with you and your colleagues to resolve them or secure information that assist you and your practice.

If you have issues or concerns with an insurance company and you would like the AAFP to be aware of and work on that issue, please submit information to the AAFP using the Practice Management Help Desk.  

Our relationships provide the AAFP a line of sight into the strategic thinking and operations of the insurers, which allows us to share information with you regarding the operations of insurers in your market. Often, the AAFP is able to help family physicians secure participation in insurers' new payment or delivery models. We also have been highly successful in connecting our state chapters with local representatives of the insurance companies. These local, state-based connections have been key to our work on increasing primary care investment.

Now, before you accuse us of cozying up to the insurers, I would like to impress upon you that the AAFP takes advantage of these meetings to raise strategic and priority issues with each company. We also use these meetings to advance our strategic objectives -- payment and practice transformation, administrative burden, workforce, and clinical expertise. This year we focused on four key issues during these meetings. Those are:

  • Administrative Burden -- The No. 1 agenda item for each meeting is advancing our strategic objective of reducing the administrative burden for our members who participate in the companies' plans. We strongly impress upon the companies the need to reduce or eliminate the use of prior authorization. There is evidence that our advocacy is impactful and we are optimistic that plans will start to reform their requirements.
  • Primary Care Investment -- We have been pressing each company to increase their overall investment in family medicine and primary care. Our goal is for each company to move from the current primary care spend, which is less than 5% on average, to greater than 12%. We specifically ask each company to report on its current spend and outline steps they are planning to take to increase that investment. This allows us to track, over multiple years, progress toward this goal.
  • Comprehensiveness -- The most immediate means of improving the overall quality and cost of health care in our country is to encourage and finance comprehensive family medicine/primary care. Whether it is management of individuals with chronic conditions, maternal mortality, rural access or greater adherence with vaccination and prevention guidelines, these issues all benefit from comprehensive family medicine. We urge the plans to emphasize family medicine and primary care, not wrap-around, insurance-directed services to improve care delivery and care coordination.
  • Quality Reporting/Evaluation -- We continue to believe that current quality improvement programs are missing the point and measuring the wrong things with respect to family medicine, and we share these opinions with the insurers. We urge them to work with the AAFP to implement quality programs that actually reflect the value of comprehensive, coordinated and continuous primary care.

This is a short overview of the AAFP's private-sector advocacy with the commercial insurance companies. We also have similar relationships and meetings with numerous other companies in the health care industry -- EHR vendors, telemedicine companies, lab companies, etc. Each of these relationships allows the AAFP to better advocate on your behalf.

Again, if you have issues, concerns or complaints please submit those to the AAFP via the Practice Management Help Desk.

Wonk Hard

On Oct. 3, the White House issued an executive order on Protecting and Improving Medicare for Our Nation's Seniors.(www.govinfo.gov) The EO, which was signed by the president at an event in Florida, is being positioned as the Republican alternative to Medicare for All and other plans proposed by Democrats and presidential candidates. In 10 categories, the collection of proposed policies in the EO includes some recommendations that are supported by the AAFP and some that the Academy opposes.

The EO directs HHS to study, develop and propose policies that achieve the order's directives under two primary timeframes -- 180 days (by March 2020) or one year (by October 2020) from the date of the EO. It is important to note that the proposed changes in policies included in the EO direct the secretary of HHS to pursue certain actions via proposed changes in regulation. The provisions of the EO do not have the effect of law; they are proposals that will require full compliance with the rulemaking process.

We have prepared a summary of the proposal(6 page PDF) and relevant AAFP policies. In addition, the AAFP sent a letter to the president outlining our support, concerns and opposition to various aspects of the proposal.

Posted at 08:30AM Oct 15, 2019 by Shawn Martin

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

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