Wednesday Dec 17, 2014

Medicaid Cuts Threaten Primary Care Practices, Access to Care

The year is ending with bad news regarding physician payment, and pending cuts may affect patients' access to care.

Section 1202 of the Patient Protection and Affordable Care Act (ACA) increased Medicaid payments for specified primary care services to Medicare payment levels for certain primary care physicians in 2013 and 2014. The provision was designed to help improve access for the significant and increasing number of Americans who are covered by Medicaid, and states received an estimated $12 billion to bolster their Medicaid primary care delivery systems during those two years. 

© 2014 Sheri Porter/AAFP

Here I am examining a young patient. Congress' recent failure to extend Medicaid parity payments for primary care will hurt primary care practices and hinder our ability to care for Medicaid patients.

More than half the states have agreed to expand their Medicaid programs, and nationally, Medicaid enrollment has increased by 7.5 million people since the fall of 2013. But with payment rates for Medicaid scheduled to revert to 2012 levels on Jan. 1, will the newly insured still be able to find care?

When the American College of Physicians surveyed its members earlier this year, 40 percent of respondents said they would accept fewer Medicaid patients in 2015 if the parity payments stopped, and 6 percent said they would stop participating in Medicaid completely if that scenario were to occur.

The reaction isn't hard to understand. On average, Medicaid pays physicians less than 60 percent of what Medicare pays for primary care services, and that gap discourages many primary care physicians from treating Medicaid patients. In fact, when the ACA became law in 2010, 36 percent of family physicians surveyed by the AAFP were not accepting new Medicaid patients because of low reimbursement rates, and 20 percent of our members surveyed were not seeing any Medicaid patients at that time.

Unfortunately, with only a two-year period in which outcomes can be considered -- combined with delays in the implementation process -- it is difficult to judge how much of an impact the parity payments made on access. Physicians were asked to expand access to their practices while facing the stark reality that they might have to either accept reduced payment for treating those patients or turn their backs on those new patients after a relatively short time. Sadly, that choice will soon be at hand unless the 114th Congress acts when it convenes in January.

The good news -- for some -- is that more than a dozen states have indicated they will maintain Medicaid parity payments even without federal funds. From these states, we may be able to better judge how physician payment affects patient access and outcomes. A much larger number of states, however, have said they will not extend Medicaid parity.

The pending payment cuts will vary from state to state, but on average, Medicaid payment for primary care will fall 42.8 percent. The largest cut would be in Rhode Island, with a 67 percent drop, while physicians in California, New York, New Jersey, Florida and Pennsylvania would all see reductions of more than 50 percent.

Unfortunately, many states will have physicians who are unable to keep their doors open to Medicaid patients because of low reimbursement rates. This will once again force patients to get the wrong care in the wrong place at the wrong time, utilizing emergency rooms for both acute and chronic care issues. The goal of our advocacy efforts on this issue has been to ensure that patients get the right care, in the right place, at the right time, and from the right person. That means ensuring access to primary care, where health issues can be identified and treated before they progress too far down the clinical pathway.

Will the end of parity payments affect the number of Medicaid patients in your practice?

Reid Blackwelder, M.D., is Board chair of the AAFP.

Friday Oct 31, 2014

Initiatives Highlight Family Medicine as Top Choice for Students

When I decided during my undergraduate studies to go to medical school, I knew that I wanted to build relationships with patients, serve vulnerable populations and become a patient advocate. I never expected, though, to be where I am today, embarking on a year that will involve representing medical students across the country and working alongside people who have become some of my personal heroes. But as the student member of the AAFP Board of Directors, that's exactly what I'm doing.

As this new door opens, so does another: the Family Medicine for America's Health project and its recently launched, public-facing campaign, Health Is Primary. What a great and exciting time to be a future family physician!

 Here I am talking with former AAFP President Glen Stream, M.D., M.B.I., the board chair of Family Medicine for America's Health. Dr. Stream discussed Family Medicine for America's Health and the Health is Primary campaign with medical students Oct. 24 during AAFP Assembly in Washington.

Check out FMAHealth.org for history and details on this game-changing project, which takes a comprehensive approach to setting family medicine on a track to lead health care transformation that will deliver value and improve the health of Americans.

I'm excited to see the contributions of my peers and colleagues in this project. This initiative wasn't the product of just a small group of disconnected decision-makers working behind closed doors. Medical students, residents and new physicians were involved at every step during the past year-and-a-half of the project's development. They contributed their visions of, and high expectations for, how patients are going to be better served by family physicians and our health care system moving forward. More importantly, patients were involved in this project, and their needs and expectations are being held in the highest regard (as they should be).

The project charges family medicine to lead the way to better care for patients, going beyond the practice of medicine to affect social determinants of health, public health efforts, population health efforts, community leadership and more.

I have struggled at times with what to tell my medical school colleagues about family medicine. I know why I'm choosing the specialty: I enjoy interacting with patients of all ages and engaging them in their health. I want to deliver babies, care for children, offer palliative care at the end of life, teach prevention, treat sports injuries and help my patients in every way that I can. But what has been harder for me to get across, at times, is why my peers should consider family medicine. Now, strengthened by this project, the reasons a future in family medicine looks so bright are more apparent than ever.

Here are a few:

  • Evidence shows family medicine is pivotal to reaching the triple aim of better care, better health outcomes and lower costs. Family physicians lead the way to more value and patient-centeredness in the health care system.
  • Family physicians are trained to practice a wide scope of medicine that is not limited by patient gender, age, health issue or organ system. As "comprehensivists," family physicians have the power to influence patients and populations in a way other specialties cannot. Family physicians are better equipped than any other specialists to manage complicated chronic illnesses, provide preventive care and, most importantly, deliver coordinated, continuing care to patients with whom they have a relationship. All of these things are shown to improve the value of care provided. 
  • The Patient Protection and Affordable Care Acts calls for physician reimbursement to be tied to quality and care outcomes, rather than volume. The payment gap between primary care physicians and subspecialist physicians should narrow accordingly. 
  • Emerging practice models, including direct primary care, will focus on the patient and deliver higher-quality care at lower cost with less waste. 
  • The graduate medical education system needs to be reformed -- and is being challenged to do so by the AAFP and others -- to deliver the physician workforce our country needs. 
  • The patient-centered medical home model of care will continue to evolve as evidence directs the movement. 
  • Preventive and chronic care management will unseat acute care as the focus of the system.

I believe more than ever that family physicians are the right group to lead this charge. The mission of family medicine aligns seamlessly with the ideals of an optimal health care system that delivers on the triple aim.

A future in family medicine offers a chance to be part of much-needed change in health care delivery, to fix a broken system and, most importantly, to make the greatest impact on the health and wellness of patients.

To quote new AAFP President Robert Wergin, M.D., someone I am incredibly excited to learn from and work alongside this year, "Why are we the answer to health care delivery in this country? We are family physicians. Enough said."

Words cannot capture the complex, coexisting feelings of humility and pride I'm experiencing from being able to serve medical students, family physicians and patients this year on the Board and to call family medicine my specialty of choice. If you haven't been paying attention, now's the time to start. Stay tuned.

Kristina Zimmerman is the student member of the AAFP Board of Directors.

Wednesday Oct 29, 2014

Spread the Word: Health is Primary

Last week I told you that the Academy and other family medicine organizations were poised to roll out a three-year national advertising campaign -- the public component of the Family Medicine for America's Health  initiative -- to educate key stakeholders and decision-makers about the value of family medicine and primary care. The campaign also is designed to educate patients and get them more involved in their own health care.

It's now my privilege, in one of my first official Leader Voices Blog posts as your president, to share the latest update from the Family Medicine for America's Health Board of Directors.

Family Medicine for America's Health
Organizational Update: October 2014

Health is Primary has launched! Family Medicine for America's Health -- a new, five-year coalition of eight national family medicine groups -- kicked off the three-year campaign last week during the AAFP Assembly in Washington. The goal is to demonstrate the value of primary care in delivering on the triple aim of better health, better care and lower costs.

I was honored to speak last week during the launch of Health is Primary. The three-year campaign aims to raise awareness of the role of primary care in improving the health care system.

The Health is Primary campaign will use national advertising, partnerships and stakeholder outreach to raise awareness of the role of primary care in improving the health care system. Family Medicine for America's Health will also drive a five-year strategic initiative to transform family medicine to meet the changing needs of the health care system.

Health is Primary will travel to cities around the country to engage local stakeholders and showcase community-level interventions that are working to enhance and expand primary care and improve health. The campaign will also partner with employers, disease groups and health advocates to activate patients on major health issues such as chronic disease management and smoking cessation and advance the use of technology tools for patient communication.

At the same time, Family Medicine for America's Health will work to modernize the family
medicine specialty and transform the nation's health care system. The strategic effort will focus
on expanding access to the patient-centered medical home, ensuring a strong primary care
workforce and shifting from fee-for-service to comprehensive primary care payment. Family
Medicine for America's Health is establishing six tactical teams with broad representation from
the primary care community that will focus on key areas for transformation: payment, practice
management, workforce education and development, technology, research, and engagement.

The campaign launch coincided with the release of a special supplement to the October issue of the Annals of Family Medicine that provides background on the planning process and the framework for execution.

To learn more about the campaign, we invite you to join us for our first webinar at 7 p.m. EST on Wednesday, Nov. 5. We will be holding these sessions periodically to update the family medicine community on our work and our progress.

Of course, you can always find us at HealthIsPrimary.org and FMAHealth.org. If you would like to donate to support the efforts of Family Medicine for America's Health, visit the AAFP Foundation website.

We are pleased to report that the board of directors for Family Medicine for America's
Health is now fully formed. Our 12th member, Lauren Birchfield Kennedy, is the director of
health policy for the National Partnership for Women & Families. Lauren fills the patient
advocate role on the Board and will bring that important perspective to the campaign.

Representative and Organization/Affiliation

  • Glen Stream, M.D., M.B.I., Chair, American Academy of Family Physicians
  • Michael Tuggy, M.D., Vice Chair, Association of Family Medicine Residency Directors
  • Paul Martin, D.O., Secretary/Treasurer, American College of Osteopathic Family Physicians
  • Jen Brull, M.D., represents full-scope, full-time practicing family physicians
  • Thomas Campbell, M.D., Association of Departments of Family Medicine
  • Jennifer DeVoe, M.D., D.Phil., North American Primary Care Research Group
  • Lauren Hughes, M.D., M.P.H., represents family physicians early in their careers
  • Vincent Keenan, C.A.E., represents AAFP chapter executives
  • Lauren Birchfield Kennedy, patient advocate, National Partnership for Women & Families
  • Jerry Kruse, M.D., M.S.P.H., Society of Teachers of Family Medicine
  • Robert Phillips Jr., M.D., M.S.P.H., American Board of Family Medicine
  • Jane Weida, M.D., AAFP Foundation

Further background, including earlier updates on this project are available on the Family Medicine for America's Health website.

Robert Wergin, M.D., is president of the AAFP.

Thursday Oct 23, 2014

We Are the Solution: Let's Spotlight Family Medicine's Value

At a state chapter meeting earlier this year I spoke with a family physician who questioned whether the AAFP's elected leaders understand and appreciate the challenges our members -- particularly small practice physicians -- face on a day-to-day basis. It wasn't the first time I had heard this comment, and it might not be the last.

The fact is I am a small-town, small practice physician. I practice full scope family medicine in the same Nebraska town where I grew up in, providing obstetric care, geriatric care and everything in between. I also am medical director for our local nursing home, a team physician for a local school and a volunteer faculty member at the University of Nebraska. I know comprehensive family medicine because it has been my life -- and my passion -- for the past 30 years.

This coming year, however, might be the most exciting yet for me and for family medicine. Today, the Academy, along with seven other national family medicine organizations, will launch a three-year national advertising campaign -- the culmination of the Family Medicine for America's Health  initiative -- using advertising, news media, online and digital communications to educate decision makers about the value of family medicine and primary care. The campaign also is designed to educate patients and get them more involved in their own health care. And work will begin this fall on the implementation of a five-year strategic planning effort.

During the next few years we will work to engage and inspire medical students to work in family medicine by connecting them with our vision for the future of health care. The number of medical students choosing family medicine has increased five years in a row, but we need even more family physicians to meet the needs of our health care system. My own son is a fourth-year medical student who is interested in family medicine, but I understand that the staggering debt many of his peers face coming out of medical school makes it difficult for some to see the rewards of family medicine.

One of the focuses for my presidential term will be to break down barriers that prevent students from choosing a career in family medicine. This needs to be approached on two fronts: debt relief for doctors who make the socially responsible choice to be family physicians and improving payment to appropriately value our services.

The current fragmented system of health care delivery is costly and of low quality. The core value of family medicine -- comprehensive, continuous and coordinated care -- is being recognized as the solution to delivering high quality, cost-effective care. Our new campaign will coincide with a five-year strategic implementation effort that will address not only  payment reform and workforce development but also practice transformation and research that supports our vision for the future of family medicine in an evidence-based way.

Another aspect of our new initiative will be to define family medicine and the scope of our specialty and to help our members practice to the full scope of their training. I tell students, "You choose your future," and I truly believe that statement sums up the advantages of family medicine. We can be as comprehensive as we want to be. If I have a patient who needs heart valve surgery, I can't provide that service. But I can find my patient an excellent surgeon who can perform that surgery, and I will be right there with my patient throughout that experience. The confidence my patients have in me is immense -- they trust me to do the right thing. I tell students they can have that same kind of relationships with their patients no matter where they choose to practice family medicine.

There are a number of new and expanding medical schools, but our country needs more family medicine residency positions to ensure that graduates have a place to continue their training. The Academy recently introduced a proposal that would drastically change graduate medical education.

Another area of emphasis for me will be to reach out to members, listen to their concerns and work to bring the joy back to practicing family medicine. Whether I'm visiting state chapters, lobbying on Capitol Hill or meeting with health plans, you can keep up to date on what I'm doing on your behalf by following me on Twitter @aafpprez and the AAFP President's Facebook page.

In this coming year we are going to shine a bright light on family medicine and define its value. This is an incredible time to be your president, and I thank you for the opportunity.

Robert Wergin, M.D., is president of the AAFP.

Tuesday Sep 02, 2014

Family Medicine for America's Health to Launch at Assembly

I am extremely excited that the launch of Family Medicine for America's Health is less than two months away; the official rollout will occur in October in Washington, D.C., at the 2014 AAFP Assembly. As president-elect of the AAFP, I want to personally invite you to be there for this big event. This is truly history in the making, placing family medicine at the center of health care delivery in our nation.

For those of you who are unable to attend the Assembly in person, stay tuned, because we are working on a plan to deliver this event to you through digital channels.

Here is our latest update on this important project.

Family Medicine for America's Health
Organizational Update No. 8
September 2014

The goal of the Family Medicine for America's Health initiative is to meet the needs of the American public by achieving the triple aim of better care, better outcomes and lower costs. This initiative includes two integrated elements: a communications program aimed at consumers, policymakers, payers and the medical community and a strategic plan that will focus on addressing key issues facing the specialty of family medicine. I will unveil the communications program at the first Assembly general session on Oct. 22.

 Family medicine's strategic direction is composed of seven statements. Working together with its health care colleagues and other engaged stakeholders, family medicine aims to achieve the following:

  • Show the value and benefits of primary care.
  • Ensure every person has a personal relationship with a trusted family physician or other primary care health professional in the context of a medical home.
  • Increase the value of primary care.
  • Reduce health care disparities.Lead the continued evolution of the patient-centered medical home.
  • Lead the continued evolution of the patient-centered medical home.
  • Ensure a well-trained primary care workforce.
  • Improve payment for primary care by moving away from fee-for-service and toward comprehensive primary care payment.

The strategic plan is focused on six key implementation areas: practice, payment, workforce education and development, technology, research, and engagement. We are in the process of developing teams that will focus on tactics in each of these six areas. These teams will rely on support and input from a broad network of expertise in family medicine and beyond. Please be on the lookout for ways you can get involved.   

We strongly welcome and encourage your input on this process. We are developing a calendar of events where you can hear directly from, and share your views with, Family Medicine for America's Health leadership about this initiative. We will work to ensure you have a wide variety of in-person and virtual opportunities for engagement. Look for a calendar of events in the next update. We are also in the process of building a website -- FMAHealth.org -- to keep you fully informed on the progress of this effort.

As a reminder, the list below shows the members of the Family Medicine for America’s Health Board of Directors and the organization or other affiliation each represents. We are still working to identify a patient advocate to join the team and expect to have that vacancy filled in time for the launch.

Representative and Organization/Affiliation

  • Glen Stream, M.D., M.B.I., Chair, AAFP
  • Michael Tuggy, M.D., Vice Chair, Association of Family Medicine Residency Directors
  • Paul Martin, D.O., Secretary and Treasurer, American College of Osteopathic Family Physicians
  • Jen Brull, M.D., represents full-scope, full-time practicing family physicians
  • Thomas Campbell, M.D., Association of Departments of Family Medicine
  • Jennifer DeVoe, M.D., D.Phil., North American Primary Care Research Group
  • Lauren Hughes, M.D., M.P.H., represents family physicians early in their careers
  • Vincent Keenan, C.A.E., represents AAFP chapter executives
  • Jerry Kruse, M.D., M.S.P.H., Society of Teachers of Family Medicine
  • Robert Phillips Jr., M.D., M.S.P.H., American Board of Family Medicine
  • Jane Weida, M.D., AAFP Foundation
  • TBD - patient advocate

Additional background and earlier updates on this project are available online

Robert Wergin, M.D., is president-elect of the AAFP.

Wednesday Jun 18, 2014

Implementation Begins on Family Medicine for America's Health

Throughout the year, we have been using this space to provide updates on the Family Medicine for America's Health: Future of Family Medicine 2.0 project. I'm pleased to share that the planning portion of the project is now complete, and we are moving forward with implementation. Our Academy's Board of Directors recently pledged $12 million over the next five years to support implementation of both the strategic and communication plans.

In this latest update, you'll find an announcement of the members serving on the Implementation Committee, the naming of the new chair (former AAFP President Glen Stream, M.D., M.B.I.) and a summary of both the strategic and communication plans. Additional updates will be shared here as the project unfolds. Exciting times for Family Medicine!

Family Medicine for America’s Health: Future of Family Medicine 2.0

Organizational Update No. 7

June 2014

We are pleased to report that the planning phase of the Family Medicine for America’s Health initiative has been completed. As a reminder, the purpose of this effort was to develop a multi-year strategic plan and communications program to address the role of family medicine in the changing health care landscape. To read earlier updates from Family Medicine for America's Health: Future of Family Medicine 2.0, please visit the project Web page.

 The Boards of Directors of each of the seven original sponsoring organizations, plus the American College of Osteopathic Family Physicians (ACOFP), have approved both the strategic and communications plans. The eight organizations have pledged more than $20 million over the next five years to implement both plans, which are described in further detail below.

Moving forward, this effort will be known simply as Family Medicine for America’s Health. An Implementation Committee has been formed that will drive the next phase of this work. Representatives include:

  • Glen Stream, M.D., M.B.I. – Chair (AAFP)
  • Tom Campbell, M.D. (ADFM)
  • Jerry Kruse, M.D., M.S.P.H. (STFM)
  • Paul Martin, D.O. (ACOFP)
  • Norman Oliver, M.D. (NAPCRG)
  • Bob Phillips, M.D. (ABFM)
  • Mike Tuggy, M.D. (AFMRD)
  • Jane Weida, M.D. (AAFP Foundation)

Four additional members are being recruited for the Implementation Committee, representing the following stakeholder categories:

  • Family physician in full-time practice (practice size of five physicians or fewer)
  • Young physician leader in family medicine (five to seven years post-residency)
  • Patient advocate
  • AAFP chapter executive

Strategic Plan

Strategic planning consulting firm CFAR developed the strategy in an intensive eight-month effort that included:

  • A strategy survey (taken by hundreds of family physicians, as well as by other primary care health professionals).
  • Current state analysis of family medicine today and the role family medicine plays in the current health care environment.
  • Identification of scenarios depicting possible futures for family medicine that were tested at a multi-stakeholder retreat attended by family physicians, other primary care health professionals, public and mental health stakeholders, policymakers and employers.

The framework of the strategic plan is organized according to a few guiding principles:

  • Put the patient and family at the center – always.
  • Now is the time for family medicine to take up a leadership role in primary care, including reforming payment in ways that make it possible for family physicians to offer patients and their families the highest quality primary care.
  • Family medicine must clearly state its vision for the next five to seven years and pursue actions specifically linked to strategies in six critical areas: practice, payment, workforce education, technology, research and engagement.
  • Family medicine can’t prove the value of primary care alone. Family medicine leaders must take a leadership role in building partnerships and alliances with a variety of stakeholders in the wider health care system – with patients, other primary care health professions and national policy organizations, among others.

The complete strategic plan will be published in an article in the Annals of Family Medicine later this year.

Communications Plan

Communications consulting firm APCO Worldwide conducted extensive quantitative and qualitative research to develop an evidence-based communications program to demonstrate that family physicians are leaders in the new and evolving health care environment and advocates for patient health. (Detailed findings of the research are provided in earlier editions of the monthly reports.) The plan outlined the following goals:

  • Position family physicians as leaders and central to the delivery of quality care for patients.
  • Increase patient understanding of the value of primary care and of receiving primary care through a family physician.
  • Improve patient engagement in prevention and health care management.
  • Attract the best and brightest students to the practice of family medicine.
  • Shift the payment model to support comprehensive payment reform.

Stakeholder perceptions of family physicians are favorable and higher than those of almost every other medical specialty. With these favorable perceptions come high expectations. The research showed that patients want and need a primary care physician – particularly a family physician – to be at the center of their health care.

A number of concepts and themes were tested for this effort. The winning theme will be launched in October at the AAFP Assembly in Washington, D.C.

This campaign will be used as an advocacy platform to communicate with consumers about their critical role in creating a strong primary care system that improves health. Research examined an exhaustive list of areas where stakeholders believe family medicine must focus. The four focus areas that emerged as most relevant and needed were: prevention and health promotion, health disparities, patient education and engagement, and chronic and complex disease management.

The communications strategy will drive broad, long-term social goals, while strengthening family medicine’s identity, cohesion and capacity to deliver on the triple aim (improving patient care and outcomes and lowering costs). The campaign will use integrated communications and will include policymaker outreach, workplace outreach, paid media, earned media placements, stakeholder engagement, corporate and organizational partnerships, and a strong online presence.

Next Steps

We will continue to provide regular updates on the implementation of this important effort. Watch these reports for opportunities to learn more and weigh in on the process.

Jeff Cain, M.D., is board Chair of the AAFP.

Friday Feb 28, 2014

Future of Family Medicine 2.0 Gathering Information, Insights

Last fall, the Family Medicine Working Party launched an initiative to define the role of the 21st century family physician and ensure that our specialty can deliver the workforce to perform this role. Here is the latest update on the progress of this important project.

Family Medicine for America’s Health: Future of Family Medicine 2.0

Organizational Update No. 6

February 2014

We are entering the final months of the Family Medicine for America’s Health: Future of Family Medicine 2.0 initiative. As a reminder, the purpose of this effort is to develop a multi-year strategic plan and communications program to address the role of family medicine in the changing health care landscape. To read earlier monthly updates from FFM 2.0, please visit the project web page.

In February, the FFM 2.0 Steering Committee and Core Teams held a retreat that included approximately 60 members of the family medicine community and 40 external stakeholders, including payers, patient advocates, employers and providers outside of family medicine. The purpose was to seek a range of perspectives as we narrow in on the strategic commitments of family medicine for the next five to seven years. Although there is still much work to do, our Steering Committee came away energized by two realizations. First, although retreat participants did not always agree on tactics, they are very much in agreement about the need for change to improve health outcomes and lower health care costs in this country. Second, because of the alignment around this purpose, the time is right to explore how family medicine can collaborate with others in the health care ecosystem to bring about the changes in primary care we all seek.

In addition to the stakeholder retreat, we hosted our first of three virtual town hall meetings to hear from practicing family physicians and family medicine educators, and to inform them about the work done to date. More than 225 individuals joined this town hall meeting. The wide-ranging conversation touched on issues related to practice, education and payment for primary care. An archived version of this first town hall meeting is available online.

There will be two additional virtual town hall meetings: 8 p.m. EST on March 5 and 8 p.m. EST on March 26. You can register for the March 5 event by clicking here

Following is an update on the progress and status of the FFM 2.0 project:

Strategic Plan

CFAR, the consulting firm leading the strategic planning process, is now in the process of analyzing the output of the strategy retreat and working with members of the Core Team on a set of recommended strategic commitments. CFAR also will continue to work with the members of the Insight Groups to test the rationale for these strategic commitments and their corresponding tactics. The Insight Groups include medical students, residents and young leaders in family medicine who are in the early years of practice. The Steering Committee then will review the recommended strategic commitments in April.

Communications Plan

APCO Worldwide, which is leading the communications planning, has completed the quantitative research elements of the project. (Please see update No. 5 from January for more information on the results of the opinion survey). APCO has developed broad concepts that define the external understanding of family medicine. These concepts focus on defining family medicine within the context of primary care and demonstrating the overall value of a system based on comprehensive primary care. APCO will test its concepts in a series of focus groups. Once themes and messages are defined, APCO will develop a comprehensive communications plan aimed at reaching two key audiences: consumers and policymakers/influencers.

Seeking Your Input

Your feedback is critical to this process. We welcome and encourage your comments and questions and have a dedicated email address for input. Since our first report on this initiative, we have received hundreds of comments to this address -- all have been very valuable to the Steering Committee and Core Team.

Please continue sharing your thoughts at futurefm@aafp.org.

Jeff Cain, M.D., is Board Chair of the AAFP.

Wednesday Dec 18, 2013

Future of Family Medicine 2.0: What's Your Opinion?

It's time for another update on Family Medicine for America's Health: Future of Family Medicine 2.0. In addition to providing you with details of the latest actions related to this important project, the update below offers family physicians an opportunity to provide input on four specific questions related to payment models, family physician training, research and the triple aim (improving patient care and outcomes and lowering costs).

You can address the questions below -- and offer other thoughts on the project -- at FutureFM@aafp.org.

Family Medicine for America’s Health: Future of Family Medicine 2.0

Organizational Update No. 4

Dec. 17, 2013

This is the fourth update of the Family Medicine for America’s Health: Future of Family Medicine 2.0 initiative. The goal of this effort, which was launched in late August, is to develop a multiyear strategic plan and communications program to address the role of family medicine in the changing health care landscape.

      As a reminder, the Family Medicine Working Party identified a set of key principles that will underpin this effort:

  • Deliver on the triple aim: improving the health of the population; enhancing the patient experience of care (including quality, access, and reliability); and reducing, or at least controlling, the per-capita cost of care.
  • Focus on the needs of residents and medical students, as well as practicing family physicians.
  • Manage the tension between addressing the needs of family medicine as a specialty and needed changes to the health care system of which it is a part.

Strategic Plan

CFAR, the strategic consulting firm hired for this project, is now working on its "current state" analysis. This document is designed to create a shared understanding about where the profession is today. This shared understanding serves as a foundation on which to build an implementable strategic plan that identifies risks to take, investments required to do so, and a realistic understanding of how to bridge the gap between the current state and the desired future we want to create. Following are the key issues that are being examined as part of this process:

  • Core attributes: What are the core attributes of family medicine today, and what do they need to be in the future, for our profession to achieve the triple aim in the service of our patients and the larger health care landscape?
  • Evolving ecosystem: How should family medicine change in response to the challenges of an evolving health care system to best meet the needs of the nation?
  • Education: What changes are needed in the continuum of education (from medical school through residency and into CME) to train the family physicians needed in the new health care system?
  • Communicating value: How do we best communicate to relevant stakeholders the value and benefits of family medicine and the important role family physicians play in meeting the health care needs of the U.S. population?

CFAR has sought broad input from family physicians -- and those who work alongside them -- in the development of the current state analysis. This has included

  • conducting in-depth interviews with thought leaders and stakeholders in the field of family medicine; and
  • conducting a strategic options survey designed to test the assumptions the community holds about the present, as well as perspectives on strategic choices in the future. The survey was sent to more than 6,000 front-line family physicians, as well as a variety of other primary care health professionals, such as OB/Gyns, general internists, nurse practitioners and physician assistants and physicians early in their careers.

     We encourage feedback and would welcome input from family physicians through our dedicated email address FutureFM@aafp.org on the following questions:

  • Can you share any examples of family physicians -- yourself included -- who are working in payment environments other than fee-for-service? How has that experience affected their practice (or your own)?
  • What are some concrete steps family medicine can take to increase the number of family physicians trained to meet the needs of the American public in the future?
  • How can the leadership of family medicine help family physicians meet the demands of the triple aim (improved patient care, improved health of populations, lower cost)?
  • What kinds of research would help improve your practice?

Communications Platform

      APCO Worldwide, the communications consulting firm, is conducting research to develop the communications platform to reflect the strategic plan. APCO has conducted in-depth interviews to elicit attitudes and opinions about family medicine from external audiences including policymakers, major insurers, employees and purchasers and other primary care health professionals. These interviews focused on perceptions of family physicians, the role of family physicians in the new health care era and the future of family medicine. Following is a brief summary of the findings:

  • There is marked appreciation for the skills and patient rapport that family physicians bring to health care.
  • Family physicians are viewed as having a solid diagnostic ability based on their scope of medical and clinical knowledge.
  • Treating the entire family gives family physicians an advantage compared with other primary care physicians in being able to consider social and behavioral dynamics in their diagnosis and treatment.
  • Expertise in prevention and education helps position family physicians for the new health care landscape.
  • Family physicians are seen as the natural choice to lead the patient-centered medical home and accountable care organizations, coordinating care and stressing wellness.
  • There is a strong belief that new comprehensive care models provide family physicians the greatest opportunity to succeed in the new system.
  • Retail clinics are seen as the greatest threat to the family physician.
  • Most cannot imagine a health care system without family physicians.

APCO currently is conducting the quantitative research element of the communications planning process. The results of its broad public opinion survey will be presented in January.

We strongly encourage you to share your input. Again, you can provide feedback at FutureFM@aafp.org. We welcome comments on the items outlined above or other suggestions/insights that would be useful to this process.

Upcoming Meetings

The fifth meeting of the Core Team will be Jan. 9. The next combined meeting of the Working Party, Steering Committee and Core Team will be Jan. 16-18.

Jeff Cain, M.D., is Board Chair of the AAFP.

Wednesday Dec 04, 2013

Students, Young Physicians Provide Insights for Future of Family Medicine 2.0

Have you offered your opinion on the Future of Family Medicine?

Your opinion matters, and now is the time.

In our first update on Family Medicine for America's Health: Future of Family Medicine 2.0, you had a chance to learn about our initiative that aims to define the role of the 21st century family physician, including scope of practice and our role within the health care system.

In our December update below, we address some of the important questions being considered by the work group and introduce you to the young physicians, residents and medical students who have been selected to help answer those questions.

You can share your thoughts directly with us at FutureFM@AAFP.org. And you can be sure we will continue to share updates on our progress.

Family Medicine for America's Health

(Future of Family Medicine 2.0)

December 2013

The Family Medicine for America's Health (Future of Family Medicine 2.0) initiative is moving forward according to schedule. The purpose of this effort is to develop a multiyear strategic plan and communications program to address the role of family medicine in the changing health care landscape. 

      The Core Team held two meetings in November. The meetings focused on CFAR's "current state" analysis and APCO's opinion research. The current state analysis is designed to create a foundation on which to build an implementable strategic plan that identifies risks to take, investments required to do so, and a realistic understanding of what it will take to bridge the gap between the current state and the desired future we want to create. During the meetings, there has been significant discussion about scope of practice, compensation and the impact of technology on the specialty. 

To address some of the key questions and ensure broad input in the process, the CFAR team is focused on organizing two “Insight Groups” designed to engage and elicit feedback on the future of family medicine. The first group includes medical students and residents. The second group includes young leaders who are in their early years of practice. Each of the seven family medicine organizations nominated two participants to each of the groups. Please see below for names of the 28 individuals who were nominated.

Discussions with these Insight Groups are being facilitated by Dr. Bob Graham, Dr. Larry Green, and Dr. Jim Martin. Members will contribute their perspective throughout the FFM 2.0 process. This will include

  • participating in discussions about the future of family medicine with their facilitators;
  • reviewing and reacting to the work produced by the Core Team and the Steering Committee; and
  • meeting in person with the Core Team, Steering Committee, and a variety of stakeholders within and outside of family medicine at a strategic planning retreat in February. 

APCO, which is leading the communications strategy element of the project, has completed a series of in-depth interviews with policy experts, payers, employers and specialists outside of family medicine. APCO's interviews will inform the quantitative element of their research, which includes a survey of a wide group of family medicine stakeholders. The results of that survey are expected in January.

We strongly encourage input from family physicians. Since our first report on this initiative, we have received more than 100 comments to FutureFM@aafp.org.

      Following are several of the key questions the Core Team is considering as CFAR develops the current state analysis. We welcome input on these questions or general comments via FutureFM@AAFP.org.

  • Is the patient-centered medical home (PCMH) the model of the future?
  • How will the PCMH model need to evolve to meet the demands of the Triple Aim?
  • Is population health a key part of family medicine? How should family medicine integrate with public health?
  • How will disruptive technology alter the practice of family medicine?
  • What changes are needed in the current payment structure to support the future of family medicine?
  • What data is available/needed to support changes in payment structure?
  • How does a narrowing scope in maternity and children's care impact the practice of family medicine?

The Core Team and Steering Committee will meet on Dec. 8. We will continue to provide monthly updates throughout this process.

Insight Group Members

Young Leaders (with nominating organizations)

  • Michael Coffey, M.D., Somerville, Mass. (AAFP)
  • Christina Kelly, M.D., Harker Heights, Texas (AAFP)
  • Brooke Sciuto, M.D., Sacramento, Calif. (AAFP Foundation)
  • Gretchen Dickson, M.D., M.B.A., Wichita, Kan. (AAFP Foundation)
  • Kurt Lindberg, M.D., Holland, Mich. (ABFM)
  • Amy McIntyre, M.D., M.P.H., Butte, Mont. (ABFM)
  • Melissa Nothnagle, M.D., M.Sc., Pawtucket, R.I. (ADFM)
  • Jill Endres, M.D., Iowa City, Iowa (ADFM)
  • Carl Covey, M.D., Las Vegas (AFMRD)
  • Carla Ainsworth, M.D., M.P.H., Seattle (AFMRD)
  • Lauren Hughes, M.D., M.P.H., Ann Arbor, Mich. (NAPCRG)
  • Rebecca Etz, Ph.D., Richmond, Va. (NAPCRG)
  • Alisahah Cole, M.D., Charlotte, N.C. (STFM)
  • Brett White, M.D., San Diego (STFM)

     Students and Residents (with nominating organizations)

  • Tate Hinkle, Brownsboro, Ala. (AAFP)
  • Kimberly Becher, M.D. (AAFP)
  • Nathaniel Lepp, M.P.H. (AAFP Foundation)
  • Jessica Johnson, M.D., Portland, Ore. (AAFP Foundation)
  • Charles Salmen, Brisbane, Calif. (ABFM)
  • Kathleen Barnes, M.D., M.P.H. (ABFM)
  • Jason Valadao, Wauwatosa, Wis. (ADFM)
  • Jillian Fickenscher, M.D., Omaha, Neb. (ADFM)
  • Natasha Bhuyan, M.D., Phoenix (AFMRD)
  • Kari Sears, M.D., South Bend, Ind. (AFMRD)
  • Vanessa Stagliano, Sagamore Hills, Ohio (NAPCRG)
  • Richard Bruno, M.D., Baltimore (NAPCRG)
  • Rebecca Mullen, Overland Park, Kan. (STFM)
  • Nicholas Cohen, M.D., Cleveland (STFM)

Jeff Cain, M.D., is Board Chair of the AAFP.

Tuesday Oct 29, 2013

Shaping the Future of Family Medicine

A few months ago, the Family Medicine Working Party launched an initiative to examine the challenges and opportunities facing our specialty and define a path forward in a rapidly changing health care system.

Family Medicine for America's Health: Future of Family Medicine 2.0 is specifically designed to define the role of the 21st century family physician, including key attributes, practice scope and role within the health care system, and to ensure family medicine can deliver the workforce to perform this role via medical school/residency training and re-engaging existing family physicians, among other things.

When this project launched, we promised to share regular updates on its progress. Here is the latest information.

Family Medicine for America’s Health: Future of Family Medicine 2.0

Organizational Update #2

October 2013

As many of you know, the Family Medicine for America’s Health: Future of Family Medicine 2.0 initiative launched in late August. The purpose of this effort is to develop a multiyear strategic plan and communications program to address the role of family medicine in the changing health care landscape.

      As a reminder, the Family Medicine Working Party identified a set of key principles that will underpin this effort: 

  • deliver on the triple aim: improving the health of the population, enhancing the patient experience of care (including quality, access and reliability), and reducing, or at least controlling, the per capita cost of care;
  • focus on the needs of residents and medical students, as well as practicing family physicians; and
  • manage the tension between addressing the needs of family medicine as a specialty and needed changes to the health care system of which it is a part.

The first of seven Core Team meetings was held on Oct. 15 in Chicago. The consultants retained for this project -- CFAR and APCO Worldwide -- have begun the research phases of their respective plans. CFAR conducted a series of interviews with family medicine stakeholders. Interviewees included family physicians practicing and teaching in a variety of settings, public health and mental health teachers and practitioners, osteopaths, physician assistants, nurse practitioners, and other specialists. The insights gleaned from the interviews will be used to inform CFAR's Strategic Options Survey, which launched during the week of Oct. 21 and will remain open for two weeks. CFAR also will begin gathering and working with data from a range of sources to build a solid understanding of the current state of family medicine, its strengths and its challenges.

APCO is conducting in-depth interviews with health policy experts, payers, health plan purchasers, other primary care professionals and specialists to gather insights and recommendations related to how these external stakeholders view family physicians. These discussions will inform the quantitative element of their research, which includes surveys of a wide group of family medicine stakeholders. This research will be used to guide the development of a comprehensive communications plan.

At the meeting, CFAR and APCO briefed the Core Team on feedback from their interviews. Issues surrounding scope of practice and length of training emerged as significant themes, particularly in the CFAR interviews. Additional questions arose from both CFAR and APCO's discussions that will require further discussion and evaluation, including

  • Are family physicians “specialists” or “comprehensivists” who provide longitudinal care?
  • What is the “unifying theme” among the diverse archetypes of family physicians?
  • How do family physicians approach the needs and wants of patients differently than do other physicians?
  • Do family physicians believe they have a mandate to lead the patient-centered medical home effort or are they deferring to others?
  • What impact will technology and big data have on the practice of family medicine?

Since our first report to members on this initiative, we have received more than 140 comments to FutureFM@aafp.org. We are pleased that family physicians are taking the time to provide input and would encourage others to share their views through this dedicated e-mail address. We are closely reviewing comments and are incorporating suggestions into the planning process.

The second meeting of the Core Team will be Nov. 13. We will continue to provide updates throughout this process. We strongly encourage input and feedback and invite you to share your thoughts and recommendations by email to FutureFM@aafp.org.

Following are members of the Steering Committee and the Core Team.

Steering Committee

Samuel Jones, M.D. (ABFM) -- Committee Chair

Stacy Brungardt (STFM)

Ardis Davis (ADFM)

Frank deGruy, M.D. (NAPCRG)

Kevin Helm (AFMRD)

Douglas Henley, M.D. (AAFP)

Grant Hoekzema, M.D. (AFMRD)

Jason Marker, M.D. (AAFP Foundation)

James Puffer, M.D. (ABFM)

John Saultz, M.D. (STFM)

Kurt Stange, M.D., Ph.D. (NAPCRG)

Glen Stream, M.D., M.B.I. (AAFP)

Barbara Thompson, M.D. (ADFM)

Jane Weida, M.D. (AAFP Foundation)

Core Team

Tom Campbell (ADFM)

Jennifer DeVoe, M.D., D.Phil. (NAPCRG)

Jerry Kruse, M.D. (STFM)

Bob Phillips, M.D. (ABFM)

Glen Stream, M.D., M.B.I. (AAFP)

Mike Tuggy, M.D. (AFMRD)

Mary Jo Welker, M.D. (AAFP Foundation)

Jeff Cain, M.D.is Board Chair of the AAFP.

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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.