Miriam E. Tucker

October 24, 2014

WASHINGTON — The American Academy of Family Physicians (AAFP) and seven other family medicine organizations have launched a new campaign to promote the central role of primary care in achieving better health for the United States.

Health Is Primary will sponsor tours to communities around the United States to identify successful models of healthcare delivery. The campaign will also engage with employers, disease groups, health advocates, and other stakeholders around major health issues, such as chronic disease management and smoking cessation, and will explore best practices in technology. The campaign's website is www.healthisprimary.org.

"This is really an extraordinary time for healthcare delivery in our country. We have so much opportunity not just to change the system but to use this momentum in a way that will actually help patients get healthy and stay healthy. And we can do that as family physicians of this country," AAFP President Robert Wergin, MD, a family physician from Milford, Nebraska, said in a press briefing held October 23, during the American Academy of Family Physicians Assembly.

This new initiative to engage the public coincides with a recently established organization called Family Medicine for America's Health (www.fmahealth.org). Family Medicine for America's Health aims to modernize the specialty of family medicine by expanding access to the patient-centered medical home, ensuring an adequate workforce, and shifting away from fee-for-service to comprehensive primary care management.

The chair of that effort, Glen R. Stream, MD, a family physician in Rancho Mirage, California, said during the briefing, "We have the most expensive healthcare system in the world, yet we rank almost last amongst industrialized countries in patient health.

"The good news is we believe our country is at a tipping point. A number of major shifts, including the Affordable Care Act, the establishment of the patient-centered medical home, and improvements in technology, have changed the landscape. We believe these represent an opportunity to truly transform and improve our nation's health."

Donald Berwick, MD, president emeritus and senior fellow at the Institute for Healthcare Improvement and former administrator of the Centers for Medicare and Medicaid Services and a recent unsuccessful candidate for governor in Massachusetts, outlined the "foundational framework of the campaign, the so-called Triple Aim concept of healthcare: better health, better care, lower cost.

"These three basic aims together constitute a system to define the social need that healthcare ought to address to survive as an enterprise," he said.

The "better care" part is the one most familiar to physicians, but the other two are just as crucial. In fact, healthcare itself contributes only about 10% to actual health outcomes. Approximately 50% is genetic, and the other 40% is everything else, including environment and individual behavior. "The leverage on health status isn't very strong when you're using only healthcare to address it.... If we're going to work on health, we've got to get out of the healthcare box," Dr Berwick commented.

This new family medicine initiative, he said, lays out a way of achieving the Triple Aim from the "inside out," by clinicians themselves, as opposed to payers and regulators and other interested parties. "Those who are entrusted with the production of healthcare in America now have an opportunity to embrace a bigger set of goals.... The best solution for America's achievement of the Triple Aim is clinician-led, patient-engaged, inside-out progress."

The Choosing Wisely campaign (www.choosingwisely.org) ― a multistakeholder effort among medical specialities to identify overuse of resources ― is a good example of that, he noted.

According to Dr Stream, elevating primary care is the way to transform the nation's health. "We believe the solution to many if not all of our healthcare problems can be found in primary care. We are so convinced of it, we plan to spend the next 3 years making the case to patients, payers, and policymakers that a strong primary care system will allow us to deliver on the promise of the Triple Aim."

Evidence supports the effect of primary care, he said. Deaths due to cancer, heart disease, and stroke are lower in areas of the country where there are more primary care providers per population. An increase of just one primary care provider per 100,000 people translates to significantly reduced utilization, including outpatient, inpatient, and emergency department visits.

And, he noted, primary care is associated with a more equitable distribution of health in populations. Healthcare costs are 33% lower among adults who have primary care physicians, and Medicare spending is lower ― yet healthcare is more effective and of higher quality ― in states with more primary care physicians.

"Health, quality, and costs: That is the triple aim you must achieve, and we believe primary care can best deliver it."

A full statement of the Health Is Primary initiative was published this week in a supplement to the Annals of Family Medicine.

In addition to the AAFP, other organizations participating in Family Medicine for America's Health are the American Academy of Family Physicians Foundation, the American Board of Family Medicine, the American College of Osteopathic Family Physicians, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the Society of Teachers of Family Medicine. Dr Wergin and Dr Stream have disclosed no relevant financial relationships.

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