Tuesday, October 19, 2010

Family medicine leadership

A recent commentary in the New England Journal of Medicine by family physicians Thomas Bodenheimer and David West examines how the city of Grand Junction, Colorado has managed to provide above-average quality health care with Medicare costs that are 24% lower than the national average. The explanation that Grand Junction residents are simply healthier that residents of other U.S. jurisdictions doesn't hold water. So what differences in the health care system of this community can be credited for its remarkable results - and applied to other communities across the country? Bodenheimer and West answer:

We believe that seven interrelated features of the health care system that may explain the relatively low health care costs could be adapted elsewhere. These are

leadership by the primary care community;

a payment system involving risk sharing by physicians;

equalization of physician payment for the care of Medicare, Medicaid, and privately insured patients;

regionalization of services into an orderly system of primary, secondary, and tertiary care;

limits on the supply of expensive resources, including specialists, beds, and equipment;

payment of primary care physicians for hospital visits; and

robust end-of-life care.

Although these innovations are mostly common sense, the perverse financial and political incentives that drive the U.S. health system (before and after the implementation of this year's reforms) present obstacles to many of them, from equalization of physician payment (requiring fresh infusions of dollars from tight state and federal budgets) to the appallingly inaccurate portrayal of end-of-life care as "death panels" (see my previous posts here and here).

We're just two weeks away from a midterm election that will likely alter the national political landscape, but no matter which party ends up with a legislative majority, patients and physicians can't look to the parties for sensible health policy solutions. To improve population health in this country, the professionals who care for the "folks" - family physicians and other primary care clinicians - need to lead the way by advocating for changes that will give every community a fighting chance to replicate the successes of Grand Junction.