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Tuesday Jan 20, 2015

Finding a Way Forward, Together

I recently had the opportunity to join HHS Secretary Sylvia Burwell for a small event where she outlined the visions, goals and objectives of the department for the final two years of the Obama Administration in a speech entitled, “Common Interests; Common Ground – Finding a Way Forward, Together.” Although these types of speeches are common in Washington, D.C., this time of the year, the subject matter discussed was quite refreshing.  

Burwell expressed a desire to identify areas of common interest with Congress and, as is noted in the title of her speech, “find a way forward, together.” She focused on goals that were achievable versus ideological, and she promoted issues that historically have had strong bipartisan support. She is not naive. She understands the political challenges presented by the Patient Protection and Affordable Care Act. However, she also understands that there is capacity for meaningful work to occur on health care issues while the political debate about the ACA continues. She framed her remarks in the form of an invitation or an open call to interested parties inside and outside the federal government to work with the administration on a set of common goals.

I was struck by the level of commitment the AAFP has made to each of the priorities articulated by the secretary. Family medicine remains at the forefront of innovation in science, medicine, quality improvement, patient engagement and health care delivery. We are the physician leaders that advocate for patients and drive change in our health care system. Although the specifics of HHS policy objectives may differ from those of the AAFP, the areas of focus are aligned. These are areas that beckon for policy and advocacy work as a means of improving our health care system and the health of our population. The goals articulated by the secretary focused on six large themes:

  • Medicaid expansion;
  • A health care system that’s better, smarter and healthier;
  • Reducing substance use disorders and overdose deaths; 
  • Global health security;
  • Leadership in science and innovation; and
  • Building an innovation economy.

I would like to expand on four of these themes and share how family medicine is leading on each.  

Medicaid Expansion
Today, roughly 70 percent of family physicians participate in Medicaid. With the exception of pediatricians, that level of participation is not seen by other physician specialties. Twenty-seven states and the District of Columbia have expanded their programs. The AAFP and our state chapters continue to advocate for the expansion of Medicaid in the remaining 23 states as a means of providing health care coverage to low income individuals and families. As I have stated many times in this blog, there are two common indicators of improved health for individuals -- health care coverage and a continuous relationship with a primary care physician, most commonly a family physician. The AAFP believes that there are many pathways to expanding Medicaid that promote greater access and protect the integrity of the program, while being flexible to account for variations in each state's population and health care needs.  

The AAFP has numerous policy objectives aimed at improving Medicaid, specifically the need to ensure adequate networks of participating family physicians are available to Medicaid patients and that the program has a payment model that compensates family physicians fairly for services provided. We will continue to pursue these specific policy objectives with Congress and the administration while also continuing our work to expand access.

A Health Care System That’s Better, Smarter and Healthier
The AAFP has a long history of leadership in quality improvement as well as delivery and payment system reform. This commitment to a better health care system is as old as the discipline itself. This past year, the AAFP and the other family medicine organizations announced a major new initiative -- Family Medicine for America’s Health(www.fmahealth.org) -- that is aligned with the goal of a better, smarter and healthier health care system. The work of the campaign will focus on six strategic objectives: practice transformation, payment reform, workforce development, improved technology, family medicine research and patient/caregiver engagement. We have already initiated conversation with the administration and Congress on this work, and we look forward to working collaboratively with them and state governments on this campaign during the next five years.

Reducing Substance use Disorders and Overdose Deaths
The challenges presented by substance abuse disorders and prescription drug abuse are far too common in our country. Family physicians are on the front lines of this health care and public policy issue. As the percentage of the population using powerful drugs for chronic pain and other conditions rises, so does the incidence of abuse and overdoses. The AAFP is actively engaged in finding solutions to pain management and prescription drug abuse problems. Our strategies can be found in our policy paper, “Pain Management and Opioid Abuse: A Public Health Concern.”

The AAFP also has made this issue a focal point of our advocacy efforts at the federal and state levels. This past November, the Academy hosted a discussion at our State Legislative Conference that brought together national experts to share strategies on how to best approach these challenging issues with legislators. We also have developed resources aimed at educating patients(familydoctor.org) on the dangers of prescription drug abuse and how they can work with their family physicians to prevent or stop prescription drug abuse.

Global Health Security

This past year saw public health crises associated with respiratory virus, influenza, several antibiotic resistant bacteria and Ebola. The Ebola epidemic gripped our national attention and shed light on the importance of a strong primary care and public health system. Family medicine again was a leader for the public, physicians, elected officials and foreign aid agencies. Time magazine named the “Ebola Fighter” their 2014 Person of the Year. Family medicine should be proud that many of those recognized are your colleagues. Their contributions continue to have a positive impact on the lives of millions of people around the world.

Family physicians have always been at the front edge of public health crises, but this past year amplified just how committed family physicians are to this responsibility both domestically and internationally. In December the AAFP published a new position paper on the integration of primary care and public health. The paper recognizes the importance of strengthening community health infrastructure with a call to action to our members along with our public health colleagues.

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Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.