A process for change: a methodology for academic family medicine.

Would you like some good reading? We recommend an article by Barbara Starfi eld, pediatrician and one of the nation’s foremost clinical epidemiologists. Her comprehensive review of the literature on systems of effective health care is in The Milbank Quarterly.3 Here’s what our country needs: 1. Patient-Centered Medical Homes. Ubiquitous physician-directed practices that emphasize fi rst-contact care, patient-centered care over time, comprehensive care, integration of care among health care disciplines and within communities, family and community orientation, and cultural competence. (You don’t need to measure much here; practices like these improve outcomes and lower costs by their very nature.) 2. Universal access to care guaranteed by publicly accountable bodies. We don’t necessarily need a single payer; we just need public accountability for those who do pay. 3. Low or no copays or deductibles for primary health services. Led by the growth of Health Savings Accounts (HSAs), out-of-pocket expenses are soaring. The GAO found that HSAs are nothing more than veiled tax shelters.4 4. Similar professional earnings for primary care physicians relative to other specialists. Recent RVU updates, care coordination payments and pay-for-performance are right on target. Make sure they measure and reward practices that in reality improve the health care system. Here’s what is really amazing: These things naturally occur when there is an adequate workforce of family physicians. If you want an illustration, ask Leiyu Shi of the Johns Hopkins Bloomberg School of Public Health. His studies consistently fi nd that poor health care outcomes due to gaps in socioeconomic status are eliminated by high concentrations of primary care physicians.5 Well, that’s about it. In the long run, these changes will pay for themselves many times over. And the measurements won’t be nearly as cumbersome as you might think. It will take some guts to take on the special interests that will be resistant to such change, but family medicine is ready to step up to the plate. Jerry Kruse, MD, MSPH, and the Association of Departments of Family Medicine