Family Medicine: Preparing for a High-Performance Health Care System

Abstract

As policy leaders seek to lower costs, increase access, and improve quality in the American health care system, strengthening primary care has become a key strategy for achieving high performance. Health reform proposals under consideration in Congress include provisions that increase Medicare and Medicaid payment rates for prevention and primary care services, spread the patientcentered medical home (PCMH) model in the Medicare program, and create a payment innovation center to test and share savings with innovative primary care practices. 1 There is wide consensus that primary care is at the center of a high-performing health care system. The health professional community is leading change. The Future of Family Medicine report in 2004 set forth a new model of family medicine that is the foundation of a high-performance health system. 2 In 2007, 4 primary care professional associations endorsed joint principles for the PCMH. 3 Policy leaders have responded to the argument for the benefits to patients and the nation from a new model of care, and they are increasingly willing to commit resources to primary care with the expectation that such investment will yield returns not only in better care for patients, but also in greater value for the resources dedicated to health care. Primary care will need to undergo fundamental change in the design and delivery of care to meet these high expectations. The National Demonstration Project, launched by the American Academy of Family Physicians in 2006, is already gaining valuable experience with transforming care delivery and yielding important lessons. 4 Despite the leadership of the health professional community, change is difficult and resistance can be expected. Perhaps the greatest barrier to change is a belief that physicians are already delivering patient-centered care. A review of the performance of the health system along key dimensions is, therefore, instructive in identifying gaps in performance that can be addressed by a new model of care. In 2005, my colleagues and I 5 set forth a “2020 Vision of Patient-Centered Primary Care,” with 7 attributes of patient-centered primary care that are likely to yield cost and quality outcomes valued by patients and sought by policy leaders. These include: