The healthcare landscape is shifting rapidly, and for family physicians, that change is placing increased importance on their role within the system. Family physicians can thrive by embracing high-value, patient-centered care, coordinated among providers with the aid of technology and data exchange.
Reworking family medicine with this future in mind is a challenge that many physicians are taking on.
”I really believe that all of the things that family physicians have been doing over the years are poised to really be valued and to be core part of a true transformation,” says American Academy of Family Physicians (AAFP) President Reid Blackwelder, MD, FAAFP.
That transformation won’t occur without growing pains. Right now, health information technology developments have left many providers with enormous amounts of patient data, but lacking an effective way to share it. And in an era of increased consolidation, private-practice physicians are struggling to stay independent and financially viable.
But through increased collaboration and community involvement, physicians are finding innovative solutions to family medicine’s biggest challenges and leading the way toward its brighter future.
Collaboration and community-based healthcare
Wanda Filer, MD, MBA, an AAFP board member, is a family physician at Family First Health, a federally qualified health center with five locations throughout Pennsylvania. She practices alongside nurse practitioners, physician assistants, pediatricians, dentists and behavioral health specialists.
“When I think about team-based care, what it means is the patient can get the care they need, when they need it, by the right person,” Filer says.
Recently, a patient came into Filer’s practice having been diagnosed with a urinary tract infection (UTI) the night before at a retail clinic. She was first seen by one of the practice’s nurses. But when the urinalysis revealed unusual results, Filer was called in to make the diagnosis of an acute gall bladder, rather than a UTI.
It’s occurrences like these that make physician-led teams critical to the future of patient care. “Primary care has never been more complex,” Filer says. “Between multiple medical conditions and multiple medications, you need that expertise and that level of training to help sort out some of the harder and riskier aspects of care.”
Blackwelder says that for family medicine truly to begin transforming healthcare, the patient-centered medical home model (PCMH) must be fully implemented. Under the PCMH model, family physicians will provide care coordination for their patients in a multidisciplinary healthcare system, with ultimate goal of improving patient outcomes and reducing healthcare costs.
But getting there might not be easy, especially at a time when the industry is facing a shortage of family physicians and the financial incentives have yet to align.
Some payers have created bonus payments for PCMH participants, but family physicians are still largely uncompensated for the time they spend developing and coordinating care plans. A report from the Agency for Healthcare Research and Quality concluded that the current fee-for-service payments are not enough for physicians to pay for the additional resources and activities needed in care coordination.
Blackwelder agrees that over the next 10 years, the industry needs to move away from what he calls bullets-for-billing, “where you check a box on a patient form to support billing as opposed to impacting patient care,” and move toward value-based payment models.
But it also remains unclear if the PCMH model will lead to the healthcare costs reductions that it promised. Established medical homes across the country have touted their success. According to the Patient-Centered Primary Care Collaborative, Capital Health Plan in Tallahassee, Florida, had 40% fewer inpatient stays and 37% fewer emergency department (ED) visits under the model.
Other research has called the cost savings into question, however. A 2014 study published in the Journal of the American Medical Association found that a PCMH pilot in southeastern Pennsylvania was unable to lower costs over the course of three years.
But regardless of the model used, Blackwelder says the industry’s future success will depend largely upon provider collaboration.
“That will be the wave of the future,” Blackwelder says. “Nobody is alone. No one is isolated. No one is siloed. We can’t afford that. We have to get comfortable sharing information, recognizing that many different parts of the patient-centered home can provide care, and how we coordinate those so we don’t duplicate efforts.”
While the PCMH model can provide care coordination within a defined practice setting, for large-scale collaborative care to occur, a significant hurdle remains: electronic health record (EHR) interoperability.