December 10, 2018 04:26 pm News Staff – In recent written testimony to the Senate Health, Education, Labor and Pensions Committee, the AAFP outlined four interwoven pathways to improving primary care.
The Academy's Nov. 28 letter, provided for a committee hearing titled "Reducing Health Care Costs Through Innovation," touted advanced primary care models, stressed the importance of social determinants of health (SDOH) initiatives, and expressed continued support for direct primary care (DPC) practices and the Independence at Home program. It was signed by AAFP Board Chair Michael Munger, M.D., of Overland Park, Kan., and prepared for the fifth in a series of committee hearings examining health care costs.
"An investment in advanced primary care has been shown to spur better health outcomes and lower costs," the Academy wrote, citing a 2018 report from the Patient-Centered Primary Care Collaborative. "New primary care delivery models, namely patient-centered medical homes (PCMH), played an integral role in the success of some accountable care organizations. … On average, the programs with the higher number of PCMH primary care practices produced savings at 1.2 percent as compared to 0.6 percent for those with no advanced primary care practices."
The AAFP noted that more research is needed to determine how to further increase savings but said accountable care organizations with a strong emphasis on the PCMH model were associated with higher scores for pneumococcal vaccination and depression screening, higher composite scores for diabetic and coronary disease, and better tobacco screening and cessation rates.
Family physicians, the Academy wrote, are key to identifying and addressing SDOH for patients and their families, incorporating this information into the biopsychosocial model to promote "continuous healing relationships, whole-person orientation, family and community context, and comprehensive care."
The letter went on: "A 2018 Health Affairs report suggests that community financing programs targeted at addressing SDOH are improving health outcomes, reducing health disparities and reducing cost."
The AAFP also highlighted its leadership in addressing SDOH through its Center for Diversity and Health Equity. The Academy developed a toolkit for screening SDOH, and it offers the Neighborhood Navigator, which allows family physicians to connect their patients to local resources for food, housing and other individual needs.
Nearly 60 percent of family physicians who responded to a 2017 survey said they screen patients for SDOH, and 52 percent follow up on identified needs by referring patients to community-based social services, the AAFP pointed out.
The letter called for federal review of systems designed to address SDOH "to understand and promote best practices, identify opportunities for public-private partnerships and bring promising programs to scale."
The Academy's letter also highlighted the importance of proper support for the DPC model. The AAFP supported the Primary Care Enhancement Act of 2017, which included a provision to allow patients to use health saving accounts (HSAs) for DPC payments.
"It is our hope that DPC is included in statutory health innovations as a high-quality, patient-centered option," the AAFP wrote.
But language in the bill changed in a problematic way.
In live testimony before the committee, Lee Gross, M.D., a North Port, Fla., family physician, also called attention to shortcomings that made their way into the legislation. He pointed out that language in the bill now labels the DPC model as a health plan, which saddles the legislation with "considerable flaws that make it less helpful, perhaps even harmful for the DPC movement at large."
"By designating DPC as a health plan, it sets up conflict with the 25 states that have legislation declaring DPC is not a health plan," Gross said.
He went on: "The bill imposes the first-ever legislative cap on physician charges and potentially blocks DPC practices from accepting HSA dollars if they dispense medications."
The Academy's letter noted the importance of support for the DPC model, which it has identified as a legislative priority: "The AAFP supports the physician and patient choice to, respectively, provide and receive health care in any ethical health care delivery system model, including the DPC practice setting."
The AAFP expressed support for Independence at Home, a CMS demonstration project that provides high-quality primary care for Medicare patients with severe chronic illnesses and disabilities. In February, the project was extended for an additional two years.
"The program is based on 20 years' worth of data showing that home-based primary care is an effective way to deliver care for seriously ill patients and to produce savings," the letter said. "Research shows that the demonstration program produced high-quality care for seniors with chronic diseases and met their complex needs. We urge the committee to examine this program as its health care review process continues."
Sen. Lamar Alexander, R-Tenn., chair of the committee, said at the hearing, "I plan to take what we've learned today and from our previous four hearings and ask leading health care policy experts for specific ideas on how the federal government can reduce the cost of health care."