The U.S. health care system is under intense pressure to change from volume to value. Primary care physicians must become the leaders our health system needs us to be: finding solutions to the problems that continue to plague this system. Costs continue to rise, access to physicians is quite limited in many locations, care often remains fragmented, and quality is uneven. To provide excellent care across the country and ensure that people in our nation are healthier, primary care physicians must be on the teams that decide what health care delivery, patient-centered care, quality improvement, cost-effective care, and provider payment look like.
Despite the best of intentions over many years among practicing physicians, policy makers, health plans, payers and patients, the many remedies applied to our ailing health care system have not resulted in fully accomplishing the triple aim (better health, better experience, and better value). Depending on how long you’ve been practicing, you’ve participated in the implementation of DRGs, HMOs, EHRs, evidence-based practice guidelines, error-reduction methods, and efforts to make patients better and more empowered consumers. Yet these haven’t been enough: Costs have not been contained, an epidemic of chronic conditions only expands, and access to care has not kept pace with access to coverage. Meanwhile, joy in practice has been diminished and physicians have become increasingly burned out.
These days, changing models of health care delivery, such as the patient-centered medical home (PCMH), and changing models of payment, such as accountable care organizations, are showing promise. Without primary care physicians leading and shaping the form and function that these and other models take, however, the triple aim goals will continue to elude us and medical practice will bring us less joy.
Taking our places at the table
Just as primary care physicians lead the clinical teams that make the PCMH model effective in improving care, improving health and containing costs, primary care physicians must be among the leaders of accountable care organizations, health systems, physician education and workforce reform efforts. We must be at the table where innovations are designed, or we risk being on the menu.
Historically speaking, physicians have largely abdicated their responsibility for shaping health care delivery. Instead they’ve often opposed change, sometimes vociferously, or worse, remained silent, believing that business and politics were best left to business people and politicians.
I’m calling on my primary care physician colleagues to reverse these trends and change the vector health care towards value by stepping up to the plate in their departments, institutions, health care systems, communities, state legislatures and Congress. We don’t want the much-needed deep and broad changes to our health care system to be designed without our expertise. We need to be present when value is defined, patient outcome measurements are designed, a patient-centered medical home is defined, and responsibility and payment are allocated.
Personally, I am most passionate about health care reform and workforce planning, including building primary care capacity. We are clearly not producing enough primary care providers to meet population needs, particularly in rural and other provider shortage areas. This issue crosses all disciplines: too few physicians, nurse practitioners and physician assistants are choosing to deliver primary care. In addition to the absolute number of primary care providers, we must transform how we deliver care to deliver on the promise of the triple aim.
In part, this is because primary care needs to be revitalized. Family medicine and other primary care physicians should play a key role in making this happen as primary care becomes the “center of gravity” in our health care system, replacing the current fragmented, volume-based approach and its lack of measured outcomes. We need to build capacity for our health systems to innovate, and it is time that we make health primary.
Telling our stories on the Web
Besides holding leadership roles at the local (health care system in which I work), state and national levels — as I most strongly encourage all of my primary care physician colleagues to do as well — I’m also working with colleagues on the Web and through social media to tell the real story of primary care. We’re telling our personal stories of clinical practice and leadership because, let’s face it, primary care faces an image problem in some quarters of medicine.
To help medical students and primary care residents learn more about the engaging, important aspects of primary care specialties, we lead the #FMRevolution information campaign and support the American Academy of Family Physicians’ #MakeHealthPrimary and #HealthIsPrimary outreach efforts that support AAFP’s long-term strategy, Health Care for All: A Framework for Moving to a Primary Care-Based Health Care System in the United States.
The spirit of wanting to make a difference is what drives me to be the family physician and physician leader I am today. This is what gives me joy in my work. I suspect this is what would bring you joy, too.
Jay W. Lee is president, California Academy of Family Physicians and a founder, Family Medicine Revolution.
Image credit: Shutterstock.com