Bringing About Changes in the U.S. Health Care System
Future of Family Medicine Report Overview
Although family medicine can do much to better serve the American public and advance the discipline through implementation of the New Model of care and through modifications to family medicine education, ultimately, broader system-wide changes are needed to ensure a strong and vibrant family medicine specialty. The U.S. health care system needs to support the integrated care that patients need and want.
The FFM Project Leadership Committee believes the U.S. health care system can be improved and transformed by focusing on six strategic priorities:
Taking steps to ensure that every American has a personal medical home
Every American should have a personal medical home that provides care that is accessible, accountable, comprehensive, integrated and patient-centered. Individuals should be able to choose or change their medical home through an easy and well-defined process, and a standard health care covenant should describe explicitly the mutual expectations of the individual and the medical home.
Advocating that every American should have health care coverage for basic services and protection against extraordinary health care costs
Reform of the funding of American health care is an essential part of healing an ailing system. It is essential that every American have health care coverage that assures adequate funding of basic health care services and protection against extraordinary health care costs.
Promoting the use and reporting of quality measures to improve performance and service
Quality measurement for family medicine should be developed in order to ensure that standards of safety, timeliness, effectiveness, equity, patient-centeredness and efficiency are being met. Quality includes measures of outcomes that patients care about (discomfort, disability, death), as well as customer service and costs. These measures should assess quality at the level of the whole person and should account for patient values and priorities.
Advancing research that supports the clinical decision making of family physicians and other primary care clinicians
Better balance in research priorities and funding is needed to assure that primary care physicians have answers to the questions they confront in daily practice. To that end, family medicine needs to define its relationship to and role within the academic health center (AHC). With the emphasis of family medicine on prevention, generalism, integrated care and community, the culture of family medicine is often seen as incongruent with the culture of the AHCs, which typically focus on subspecialization and reinforce a fragmented approach. Family medicine and the AHCs need to reexamine their respective agendas for education, research and practice, and commit to a shared future around common goals. Research is also an essential component of quality and a force for continuous improvement in practices and is integral to the New Model. To make such research in education and practice a reality, a national entity should be established to foster, coordinate and fund research in family medicine and primary care.
Developing reimbursement models to sustain family medicine and primary care offices
Practice resources are insufficient in the current system to accomplish many of the tasks essential for an improved and transformed health care system. Specific recommendations regarding reimbursement and financial models for family practices are being developed by a newly formed task force, which will report its findings and recommendations by fall 2004.
Asserting family medicine's leadership to help transform the U.S. health care system
With more office visits made annually to family physicians than to any other specialists, family doctors are well positioned to have a leadership role well beyond their own specialty. It is vitally important to groom leaders within family medicine who will change the health care landscape. Avenues for professional growth and leadership training should be developed, such as convening a summit of primary care leaders and organizing a leadership center for family medicine and primary care.