Building the Foundation of a Better Healthcare System: for the Common Good

Has a fellow traveler on an airplane ever asked you what it is you do? When someone asks me the “What do you do?” question, I tell them, “I’m building the foundation of a better healthcare system.” I believe it is the destiny of family medicine to be the foundation of a new system of healthcare for the common good of the American people. I believe that our discipline was created for this moment in time when all the interested parties in the business of healthcare are looking out for their own self-interests and not the common good. As natural servant leaders, family physicians work close enough to the people to care and work for the common good. As the trainers of the next generation of family physicians, we are building the foundation of a better health care system.

I envision a system of healthcare with a medical home for all Americans. These medical homes will be created, sustained, and staffed by family physicians and our primary care colleagues. The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association have published an excellent description of the medical home entitled “Joint Principles of the Patient-Centered Medical Home.”¹ I encourage you to read these joint principles as you build the medical homes in your practice. When you build a good medical home you are building the foundation of a better health care system. The Commonwealth Fund 2006 Health Care Quality Survey provides new evidence of the value of medical homes.² Promising findings from this survey are that adults who have a medical home have improved access to care, higher rates of preventive screening, are better prepared to self-manage their hypertension, and racial disparities in access to and quality of care are reduced or eliminated.²

I believe that the medical home is the unit of primary care for this country, and that we are approaching the tipping point in the rest of the country coming to the same conclusion. What are the training implications of this? Our family medicine centers must be medical homes that truly offer an apprenticeship experience to learners at all stages from premedical students, to medical students, to residents, to fellows, to faculty. We must ensure that our residencies train our residents so that they will thrive in the medical homes of the future. Is it time for all medical students to receive training in a medical home, so they understand the foundation upon which the health care system will be built? Is it time to require a continuity of care experience in a medical home as a core competency to graduate from medical school?

One problem with the medical home model is that you can’t fund it on E and M codes alone. It requires additional reimbursement that pays for care coordination and management that occurs outside of the office visit.

Who deserves extra reimbursement as a medical home? There is an opportunity for practices to become certified as medical homes by the National Committee for Quality Assurance (NCQA) with their Physician Practice Connections program. I predict that in the near future this certification will enable medical homes to receive enhanced practice revenue. This revenue will allow us to continue the work that we do every day that just isn’t paid by office visits, such as telephone management, case and disease management, electronic medical record costs, and continuous quality improvement to name a few. A number of pilot programs are underway linking the Physician Practice Connections certification with enhanced revenue. If you review the Physician Practice Connections Standards of the NCQA (Table 1⇓) most family medicine teaching practices have already put many of the requirements into place.

We are a patient-care based specialty and our training needs to maintain that emphasis. Our job is to train our residents as the clinical equivalent of pleuri-potential stem cells. After residency, family physicians can differentiate into whatever their position or community requires. But, at the core, they were trained in the basic principles of family medicine in a medical home. I believe it is the destiny of family medicine to be the foundation of a better healthcare system for America. We are needed … for the common good.

• © 2007 Annals of Family Medicine, Inc.